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Tavistock Clinic
Series
Edited by Nicholas Temple and Margot Waddell


 

Founded in 1920,The Tavistock Clinic is recognised and respected as one of the world’s leading psychoanalytically-based psychotherapy centres. It is a mental health institute with three principal departments - Child and Family, Adolescent, and Adult - and is also one of Britain’s leading training institutions and a pioneer researcher in infant observation. The Tavistock Clinic Series, written in a clear and accessible style, offers the reader the opportunity to explore many issues, making available the clinical and theoretical work that has been most influential at the Tavistock. Contributors will examine practical clinical work, theoretical and research perspectives and such topics, amongst others, such as personality development, trauma, psychosis in children and adolescents, and eating disorders.



Mirror to Nature: Drama, Psychoanalysis and Society

Mirror to Nature
This is a thoughtful and comprehensive analysis of drama and psychoanalysis, written in the lucid and accessible manner that epitomises the Rustin's style. These two well-known authors and psychotherapists explore in depth the extent to which psychoanalysis can illuminate and give fresh perspective to areas of drama, and how far this extends in the other direction. Concentrating on well-known playwrights including Ibsen, Shakespeare, Pinter, this is a well-researched and fascinating book - Rustin, Michael & Rustin, Margaret.

Special Price: £15.29 (€UR 24.47)
RRP: £16.99 (€UR 27.18)
 
 
 

 

 
 
 
Facing it out: Disruptive adolescents from a clinical perspective
This is a practical analysis of the art of solving family disruptions caused by adolescents. Staff of the Adolescent Department of the Tavistock Clinic describe a range of disturbances, from adjustment crises to anorexia nervosa and psychosis. 256 pages. - Anderson, Robin & Dartington, Anna.



£14.99 (€UR 23.98)
 
 
 
Inside Lives - Psychoanalysis and the Growth of the Personality

 

 

 

 

 

 

 

 

 

This is an introduction to the factors which develop or inhibit the mind in all stages of life, from a psychoanalytic point of view. The book traces the interplay between influences - internal and external - which contribute to a person's character strength and sense of identity. 192 pages. This second edition of the remarkable Inside Lives (expanded with a chapter on the last years of the life cycle) provides a perspective on the relationship between psychoanalytic theory and the nature of human development which has not been available in written form. Following the major developmental phases from infancy to old age, the author lucidly explores the vital aspects of experience which promote mental and emotional growth and those which impede it. In bringing together a wide range of clinical, non-clinical and literary examples it offers a detailed and accessible introduction to contemporary psychoanalytic thought and provides a personal and vivid approach to the elusive question of how the personality develops.

‘A remarkable achievement’ - Edna O’Shaughnessy

‘The difficulty I have found in reviewing is that it is hard to adequately convey the scope, the richness, depth and literary beauty of this book.’ - Journal of Child Psychotherapy.
£14.99 (€UR 23.98)  ISBN: 1855759373
- Waddell, Margot.


 
 
 
 
 
Internal Landscapes and Foreign Bodies: Eating Disorders and Other pat
Klein's model of projective and introjective processes and Bion's model of the relationship between container and contained have become increasingly significant in clinical work. Here, the author elucidates the psychodynamics of these processes in the context of eating disorders in both sexes. 224 pages. - Williams, Gianna.



£12.99 (€UR 20.78)
 
 
 
Reason and Passion: A Celebration of the Work of Hanna Segal
One of the most influential figures within the Kleinian group of the British Psychoanalytic Society, Hanna Segal was a recent recipient of the Sigourney Award for her contributions to psychoanalysis. This is the first of two volumes examining her clinical and theoretical work. 256 pages. - Bell, David (Ed).


£14.99 (€UR 23.98)
 
 
 
Psychoanalysis and culture: A Kleinian perspective
This book provides a long-overdue view of the relationship of psychoanalysis to culture. Uniquely positioned to bridge the gap that exists between clinical and academic psychoanalytic studies, it is dedicated to the work of Hanna Segal. With contributions from leading international psychoanalysts, philosophers and sociologists. 226 pages. - Bell, David (Ed).



£14.99 (€UR 23.98)
 
 
 
Multiple Voices: Narrative in Systemic Family Psychotherapy
Part of a series, this book focuses on narrative and stories in Family Systems Therapy - particularly on how stories develop within the domain of a therapist's own theoretical, clinical and professional contexts. The aim is to allow the reader to understand the uses of stories in family therapy. 224 pages. - Papadopoulos, Renos & Byng-Hall, John (Eds).



£14.99 (€UR 23.98)
 
 
 
Assessment in Child Psychotherapy
This book describes an approach to children and young people who might be helped by child psychotherapy. Using a number of clinical examples, and showing factors such as the family and wider school and community context, it will be of great value to child and adolescent mental health professionals and to a wider public interested in child development. 180 pages. - Rustin, Margaret & Quagliata, Emanuela (Eds).

 

£14.99 (€UR 23.98)
 
 
 
Psychotic States in Children
Developments in the understanding and psychotherapeutic treatment of children and adolescents suffering from psychotic levels of disturbance are dealt with in this work. The book is chiefly concerned with children troubled in their behaviour, relationships, and communication. 224 pages. - Rustin, Margaret et al (Eds).



£14.99 (€UR 23.98)
 
 
 
Understanding Trauma: A Psychoanalytical Approach
Major disasters draw attention forcibly to their effects on the survivors. Less often examined, however, are the long-term after-effects upon an individual's emotional and working life. This book is about what follows the breakdown in functioning provoked by trauma - in the short and the longer-term. 224 pages. - Garland, Caroline (Ed).

 

£14.99 (€UR 23.98)
 
 
 
The Talking Cure: Mind and Method of the Tavistock Clinic
Talking Cure shows how the mind operates through all stages of life. Drawing on Tavistock Clinic research and case studies, it demonstrates just how much "the heart has its reasons the reason knows not of". Providing insights into many areas of contemporary life and into the challenges of the future, this book provides a valuable insight into one of Britain's foremost psychotherapeutical traditions. - Taylor, David (Ed).

£9.99 (€UR 15.98)

 

For forthcoming titles please request brochure from Karnac Books +44 (0) 20 8969 4454

 

NEW TITLE ANNOUNCEMENT

KARNAC BOOKS IN ASSOCIATION WITH THE
TAVISTOCK CLINIC ARE PROUD TO ANNOUNCE
PUBLICATION OF A NEW TITLE BY
MARGARET RUSTIN & MICHAEL RUSTIN



MAY 2002

MIRROR TO NATURE
DRAMA, PSYCHOANALYSIS AND SOCIETY
MARGARET RUSTIN & MICHAEL RUSTIN


This is a thoughtful and comprehensive analysis of drama and psychoanalysis, written in the lucid and accessible manner that epitomises the Rustins’ style. These two well-known authors and psychotherapists explore in depth the extent to which psychoanalysis can illuminate and give fresh perspective to areas of drama, and how far this extends in the other direction. Concentrating on well-known playwrights including Ibsen, Shakespeare, Arthur Miller and Harold Pinter, this well-researched and fascinating book is a valuable addition to any cultural studies library.
As the latest in the prestigious Tavistock Clinic Series, to which Margaret Rustin and Michael Rustin have contributed greatly over the years, this book demonstrates clearly the need to push psychoanalysis into new areas, thus ensuring the thinking can not ever stagnate.

£16.99 ISBN: 1855752980 Paperback Pages: 304

MARGARET RUSTIN is Consultant Psychotherapist and Head of Child Psychotherapy at the Tavistock Clinic, and has co-authored Narratives of Love and Loss, and co-edited Assessment in Child Psychotherapy, Psychotic States in Children and Closely Observed Infants.

MICHAEL RUSTIN is a psychotherapist, sociologist and political commentator. He has co-edited Closely Observed Infants, and his other works include Welfare and Culture in Europe, and Reason and Unreason: Psychoanalysis, Science and Politics.


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Robin Anderson and Anna Halton (eds)
Facing it out - Clinical Perspectives on Adolescent Disturbance
 (£14.95, 256 pp)

"A wealth of descriptive accounts of clinical practice". - Professor Issy Kolvin.

"A window onto one of the most outstanding adolescent departments in Britain". - Kevin Healey, Director, Cassel Hospital, London.

The Adolescent Department in its long history has been engaging with young people and their families when the strains prove too great. This book describes a range of disturbances from adjustment crises to anorexia nervosa and psychosis.

Robin Anderson is a Consultant Child and Adolescent Psychiatrist, Chairman of the Adolescent Department at the Tavistock Clinic and a Psychoanalyst. Anna Dartington is a Senior Clinical Lecturer in Social Work, Chair of The Young People's Counselling Service at the Tavistock Clinic and a Psychoanalytic Psychotherapist.

 




David Bell (ed)

REASON AND PASSION  A Celebration of the Work of Hanna Segal
(£14.95, 178 pp)


"An extremely satisfying book. I encourage everyone to buy it". - David Morgan, Portman Clinic, London.

Hanna Segal is one of the best known living British psychoanalysts. This book is compiled in honour of her clinical and theoretical work. It offers contributions by internationally renowned psychoanalysts. It includes an extended introductory essay reviewing her contribution to psychoanalysis and a biographical sketch.

David Bell is a Consultant Medical Psychotherapist at the Tavistock Clinic and a Psychoanalyst.


Review by Penelope Garvey

We are indebted to the Editor of the APP Journal, Psychoanalytic Psychotherapy, for allowing us to reprint this review here.



This is the first of two volumes of collected papers - many of which have previously been published - edited by David Bell to celebrate the life and work of Hanna Segal, one of the most influential psychoanalysts of our day. In her foreword, Irma Pick describes Segal's 'incise clarity of mind' and refers to her 'fierce loyalty to the people and ideas that she cares about'. It is for these qualities of reason and passion that Segal commands such enormous affection and respect, and it is these that gave Bell the title for the book.

In his excellent introduction Bell brings to life Segal's pragmatic realism and punchy style of delivery. I particularly enjoyed his description of the meeting at the Institute of Psychoanalysis in which a speaker had suggested that the Society should go along with a situation in which we would be getting ninety five per cent of what we wanted and should not be bloody-minded about the other five per cent. Segal replied by saying that it depended on the five per cent. She went on to describe a patient who had met and wanted to marry a man who was kind, intelligent, shared her cultural interests and son on. There was only one small problem, he was impotent. 'If', said Segal, 'the five per cent is the balls of the matter, then leaving it out is self-castration'. Bell also gives an interesting short biography of Segal's life and a very useful, detailed, and thorough overview of her work.

Bell describes truthfulness as the hallmark of Segal's work. He quotes the lines of Samuel Johnson used by Segal, Bion and Rosenfeld in their joint obituary to Klein: "Whether to see life as it is will offer us much consolation I know not; but the consolation which is gained from truth, if any there be, is solid and durable; that which may be derived from error must be, like its original, fallacious and fugitive." It is this capacity, of knowing what is really there internally and externally, a capacity which involves facing separation, loss and guilt, that Segal considers essential for the development of symbol formation and creativity.

Segal's theories on symbol-formation are a major contribution to psychoanalysis, and Robert Caper devotes his chapter to a very clear exposition of their development. He describes Segal's crucial elaboration of Klein as being '...that the psychotic does not stop phantasising but rather developes a phantasy about his phantasies... that they are literally and concretely true'. He shows how Segal, influenced by Bion, later modified her theory to take reality into account, and illustrates this with Segal's example of the patient who was disturbed by the sound of a motorbike - clinical material that shows beautifully the balance between past and present and phantasy and reality. I found this paper a pleasure to read and it will be immensely useful to anyone wanting to understand or teach this subject.

Alarming examples of concrete thinking and behaviour follow in Leslie Sohn's interesting paper about a small but dangerous group of patients who have committed acts of random violence, in which members of the public are attacked in the street. He argues that total intolerance for any depressive experience leads these patients to act out physically, violently, manically and in an entirely magical and concrete way reversing roles with their victims.

The clinical papers that follow, by Robin Anderson, Eric Brenman, Ruth Riesenberg Malcolm, Roy Schafer, Edna O'Shaughnessy and Betty Joseph describe patients who are unable to face separation, loss and guilt. The focus is on the different ways in which the patients defend themselves against knowing the truth. Great care is given to the detail of the sessions, with the analysts picking up subtle changes in their patients and closely examining their countertransference responses. The reader is shown how the analyst can be pulled in to subtly different kinds of enactment with their patients - an area about which there is a great deal of interest at the moment. These papers owe much to the influence of Bion and Joseph, analysts whose work has influenced Segal as much as hers has influenced theirs, and Segal is not centre-stage. At times I wondered why these particular papers had been selected. Nonetheless they are impressive papers which are enormously informative about the way in which Kleinian analysts are working today, and interesting theoretical and technical points are raised. Riesenberg Malcolm, for example, describes the difficulties of working with a very disturbed patient, but does not modify her technique; and she suggests that the analyst's ways of dealing with their own guilt affects their ability to face that a patient might be beyond repair.

Bell refers to the balance of Segal's approach between past and present, internal and external, and phantasy and reality. This balance is reflected in most of the chapters. In their non-clinical paper the Sandlers are explicit about the importance of being able to differentiate between construction (insight into the patient's current inner world) and reconstruction, and between present unconscious and past unconscious. O'Shaughnessy makes a plea in her paper for balance in what she refers to as 'the interminable debate' about transference versus extra-transference interpretations. She points out that the important question to ask is 'whether the analyst's technique wards off, rather than permits, the entry of what is new new and disturbing'.

This book contains an impressive collection of papers. The first two chapters of it focus substantially on Segal, and are essential reading for anyone interested in her work, while the other papers add an interesting variety of subtly different perspectives on clinical problems. A very useful collection for anyone engaged in clinical work.



Penelope Garvey is a Member of the British Psychoanalytical Society

 



Review by
Jean Bégoin

This book is one of a new series of publications by London's Tavistock Clinic intended to disseminate the clinical and theoretical contributions that have been most influential in the training courses run by that famous institution in the various schools of psychotherapy. Edited by David Bell, it is a tribute to the work of Hanna Segal and her influence on the psychoanalysts and psychotherapists of the 'Tavi'. What is particularly interesting about this original volume is that it is essentially clinical, nearly all the contributions being reports of analytically treated cases that give a good impression of the current state of mainly Kleinian-psychoanalytic research on the therapy of 'difficult cases'. Three of the ten authors, -Joseph, Anne-Marie Sandler and Roy Schafer, - concentrate on theoretical aspects, while nevertheless tackling the same problems, whereas all the others--Robert Caper, Leslie Sohn, Robin Anderson, Eric Brenman, Ruth Riesenberg Malcolm, Edna O'Shaughnessy and Betty Joseph, - give detailed accounts of clinical cases, which clearly illustrate the working methods of these renowned analysts and the 'technical' concerns and theoretical positions that underlie their work.

The volume begins with an introductory essay by David Bell on the work and person of Hanna Segal. As Irma Brenman-Pick notes in her brief foreword, Segal's work is so well known and her influence so indisputable that she actually needs no introduction. However, it is good to learn more about her background from the biographical information gleaned by David Bell in direct interviews with Segal herself. In particular, we hear of her Polish origins and childhood and of her exile first in Geneva and later in Paris. Here she acquired her perfect French, which was subsequently to stand her in very good stead in her relations with her French-speaking supervisees as well as with the Francophone colleagues who included close friends with whom she would often spend holidays in France. Exiled once again to the United Kingdom, she went to Edinburgh to complete her medical stuudies, and there she met Fairbairn, who introduced her to the world of psychoanalysis by giving her two books, Melanie Klein's, "The psychoanalysis of Children" and Anna Freud's, "The Ego and the Mechanisms of Defence". Her choice is a matter of record and led to her becoming the universally known presenter of Klein's oeuvre.

For all its familiarity, Segal's activity in the exposition and dissemination of the Kleinian corpus by no means constitutes the sum total of her own work, as David Bell makes clear in his vivid, in-depth review. Since her paper 'A psyche-analytical approach to aesthetics' (1952), exploration of the relationship between the many aspects of the depressive position on the one hand and art and creativity on the other has remained one of Segal's two main preoccupations. The second is the analytic investigation and treatment of schizophrenic states with the aid of the concept of projective identification described by Klein in 1946. On the basis of these researches, Segal took up and consolidated the study of symbol formation, begun by Klein as long ago as 1930 through the case of Dick, and in 1957 was able to postulate that the 'symbolic equation' lay at the root of the concrete thought of the schizophrenic.

In his contribution, 'Symbol formation and creativity', Robert Caper links the various stages of Segal's work and describes the issues raised today by the understanding of psychic development in relation to symbol formation. He points out that the capacity to symbolise calls for an increasing ability to recognise that the good object is not the subject's own self and that, in addition, good internal communication cannot evolve in the presence of excessively rigid splits. He illustrates these problems by the analysis of a young woman with an 'inhibition of self expression', giving a detailed account of a whole week's analytical sessions including the patient's dreams. This enables the author to demonstrate in particular the links between oedipal conflicts and the capacity for symbolic thought.

David Bell describes a number of other areas of Segals work, such as her contributions to the theory of analytic therapy, which have inspired many of the chapters in this book. For instance, he writes of the connection between interpretation and the 'real' aspect of the analytic relationship in terms reminiscent of those used by the French analyst Sacha Nacht, whom, however, he does not quote: Nacht stressed the importance of the concept of the analyst's 'presence' and often used to say that the analyst acted less through what he said than through what he was. Bell points out that Segal would see this as a spurious problem because it is by interpreting that the analyst shows what he is. While this may be true, it does not entirely resolve the issue which, as the various contributors in this book show, is in fact much more complex.

One of the difficulties discussed is the problem of violence, which is tackled by Leslie Sohn On the basis of three psychiatric cases of motiveless violent acts studied in an institurion and by Robin Anderson in relation to the analysis of a case of fetishistic sexual perversion, 'Putting the boots in', which may perhaps remind one of the tale of Tom Thumb and the giant's seven-league boots. Common to all such cases is a severe disorder of the capacity to symbolise associated with the utter intolerability of excessive affects involving object loss or pathological guilt. In his detailed account, Eric Brenman also describes a very difficult case, but here the patient was able to recover the memory of a severe early trauma after two years of what was his third analysis. The trauma had left the patient with intolerable hypersensitivity and ambivalence, which he defended against by a massive split that was necessary for his psychic survival. The analysis had to be broken off for external reasons after three and a half years, but, through the recognition of his own violence and the experience of the analyst's capacity to survive the attack without himself responding with violence, the patient was able to make good progress. Ultimately, therefore, contrary to all appearances the patient had secretly preserved in the depths of his being the model of a living, authentic relationship, which had effectively remained latent pending a good enough encounter.

The cases presented by Ruth Riesenberg Malcolm, Edna O'Shaughnessy and Betty Joseph all concern perversion-like resistances to analysis of greater or lesser gravity. They constitute thrilling examples of the depth and meticulous detail in which these analysts are able to follow the interactions of the transference/countertransference, while also, however, illustrating the difficulty of these situations, which are sometimes insuperable to the point of deadlock. The common element that clearly emerges in all these patients is their struggle against excessive, sometimes manifest but chiefly latent. psychic suffering, which is always so intolerable that it compels them to resort to desperate defences. All these cases surely bear witness to a failure of early infant-environment interaction that has left behind the indelible trace of an almost irreversible fundamental split, as a result of which. as one of Joyce McDougall's woman patients put it, these subjects are only able to survive but not to live. Is this not what we call 'psychosis'? Such analysands confront the analyst with very difficult technical problems of two main kinds: how to help them be born to genuine psychic life, and how to avoid the danger of the analysis itself turning into an exercise in sado-masochistic perversion.

Roy Schafer's three clinical vignettes illustrate the kind of deep disorders of introjection observed in these patients, a problem to which Segal had drawn attention. Schafer notes that these are actually disorders of incorporation, - often of partial incorporation as described by Abraham,- owing to the primary character of the level of symbolisation.
In their contribution, Joseph and Anne-Marie Sandler refer to the distinction they had drawn in earlier work between past unconscious and present unconscious, which enables them to avoid a reductionism to the level of drives that would not sufficiently allow for the complexity of children's motivations. From this point of view unconscious fantasies,- for example transference fantasies,-arise in relation to present-day objects in the here and now and in the depths of the present unconscious, but are modelled on the past unconscious. Hence not everything the patient says is to be deemed a reflection of the past, and the transference is not necessarily a mere repetition of early object relations. These formulations will surely arouse echoes in our practice.
This is an interesting book because of its rich evocation of the work of Hanna Segal, the diversity of its various authors' contributions and their exceptional clinical quality. One misses only an account of a child analysis,- a curious omission given the Tavistock Clinic's vocation of child psychotherapy.

JEAN BÉGOIN

28 rue Washington, 75008 Paris (Translated by Philip Slotkin, MA, MITI)




Margot Waddell 

INSIDE LIVES: Psychoanalysis and the Growth of the Personality
 
(£14.95, 225 pp)

"A remarkable achievement". - Edna O'Shaughnessy.

"personal, insightful...a book for specialists and non-specialists alike". - Michael Brearley

This book provides a perspective on the relationship between psychoanalytic theory and the nature of human development which is notcurrently available in written form.
Following the major developmental phases from infancy to old age, the author lucidly explores those vital aspects of experience which promote mental and emotional growth and those which impede it.
In bringing together a wide range of clinical, non-clinical and literary examples it offers a detailed and accessible introduction to contemporary psychoanalytic thought and provides a personal and vivid approach to the elusive question of how the personality develops.

Margot Waddell is a psychoanalyst and Consultant Child Psychotherapist in the Adolescent Department at the Tavistock Clinic. Together with Nicholas Temple she is editor of the Tavistock Clinic Series.


Reviews:

1 Neil Maizels

2 Isca Wittenberg

3 Angela Joyce


Review by Neil Maizels


Journal of Melanie Klein and Object Relations, Vol.17 (1), spring 1999

I remember reading an interview where the composer Ralph Vaughan Williams was expressing his worst fears about how his music would be received. He worried that the "heavyweights" might find his music too light, and the "lightweights" might find it too heavy.

This problem must be faced by an analyst wishing to communicate important psychoanalytic developments to the "wider community", and I find that only the psychoanalytic writer who has really lived the theory can do it well.

Only a handful have even dared attempt such a consuming task; beginning with Freud's encyclopedia articles, it takes a Klein, an Horney or a Winnicott to really bring it off well, and there's no need to name the embarrassing failures that have mushroomed in the 1980s and 90s.

Having said this, Margot Waddell is indeed one of the handful who really can do it well, and furthermore, she (probably without realising it) consolidates and pushes the boundaries of the theoretical ideas that she seeks to clarify and illuminate. To me, this means that she has an unique talent for repairing cracks and gaps in psychoanalytic thinking by analysts, and one of the most gaping of these has been a unified theory of the whole human lifespan, as distinct from a theory of infancy plugged in ad infinitum, or ad infantitem, to developments in later mental life.

So the title seems particularly apt, with its penumbra of associations and meanings. And one really does get an impression of an author struggling with the tension between theoretical concepts on the one hand, and the real pain, drama and accomplishments of emotional life, on the other.

The reader does not need to have read or understood Bion, Klein or Meltzer to appreciate this book, because Waddell brings them to bear only in the service of giving us a place to stand in order to grasp her slant on the vicissitudes of the struggle to remain a feeling and thinking person throughout one's lifetime. (Given that "...a child's capacity to develop and grow internally is closely related to the kind of learning that has been going on from the earliest phases of... life," p.95.)

But when she does use quotes from these authors it is never to "conquer" living conflicts with big-gun theory, but rather to bring the best living words available in order to free them from pre or mis-conception.

Her opening quotes for each chapter and life-stage are beautifully illustrative, and set the reader's mind along a feeling path even before the mental challenge has been gripped and grasped. They therefore act as a "safety-valve", ensuring that our minds are guarded...

from the thoughts
men think in the mind alone



because Waddell believes (like W.B.Yeats), that


He who sings the lasting song
thinks in a marrow bone.


I am hesitant to give a detailed account of the argument of each chapter, or of the book as a whole, for fear of stealing Waddell's thunder and lightning of expression, or of watering it down into book-reviewish summary. But, probably the opening of chapter 7, entitled "Models of Learning", catches the drift of a current that flows through all of her work.

The book is "...focused on the ordinary ways in which a person may grow up - internally as well as externally. The aim is to differentiate between the sorts of thinking and knowing which contribute to character strength and the capacity to think for oneself, and those which encourage the mere proliferation of qualifications and expertise - the 'learning' which may measure external success without increasing internal growth. What concerns us here are not matters of social values and priorities, but the most specific and personal of issues - the kinds of identification to which a child has been drawn from the very first".

Waddell uses myths, literature and clinical and dream narrative to convey this struggle, for this is not primarily a book about psychopathology, but about the conflict between growth-and-development against its imitants, pseudo-maturity (Meltzer) and group compliance.

Life is indeed a long, hard-won struggle, and we need books like this (but there are no other books like this), which

...more than other gifts, bring hope, and forward-looking thoughts (Slightly misquoting Waddell's quoting of Wordsworth, p.203).


NEIL MAIZELS, 38 Urquart Street, Hawthorn VIC 3122, AUSTRALIA


Review by Isca Wittenberg

Journal of Child Psychotherapy, Vol 25 No.3 1999

Generations of students at the Tavistock have greatly benefited from Margot Waddell's lectures on personality development. The publication of this book is a happy event, allowing us and a wider public to have access to these riches and her further thoughts on the subject. Based on the original psychoanalytic discoveries of Freud, those of Klein and post-Kleinians, drawing on many years of experience of clinical work, added to by observation of babies, children, adolescents and adults and inspired by literary sources, she now presents us with a cohesive picture of inner growth.

The story of how we grow is, as she states in her introduction, 'not told in orthodox developmental terms, nor yet as a comprehensive view of how, expositionally, psychoanalytic theory would explain such matters. It is, rather, an attempt to trace the unfolding of the inside story of the inner life of a person.’ The book tells a story, or rather many stories, of different individuals and allows us to discover the meaning each one attaches to their experiences, how they conceive of themselves and their relationship with others. The author's great gift for conveying in brief sketches, excerpts from conversations and clinical sessions something of the essence of the nature of each person, their life circumstances and their internal world enables us to establish an immediacy of contact with them, to resonate with what they think, feel, phantasize, their emotional pain and their attempts to deal with it.

The title Inside Lives may lead one to assume that the book deals exclusively with the internal world of the individual but, in fact, it is the interrelationship between the internal and external world and how they affect each other that is spread out before us in these pages. Indeed, what is demonstrated is how much the ability to develop and be in touch with one's true self is dependent on the relationship with another person, or persons, capable of helping to face, understand and contain emotional pain. The foundations are shown to be laid in infancy, in the mother's responsiveness to the baby's psychic needs - her availability to take in, digest and transform the projected anxieties which are too overwhelming for the immature psyche to bear. Yet at the same time we learn how hard it is to find a self when right from the start, already in utero, the infant is bound to some extent to be affected psychosomatically by the parents' preconceptions about him rather than his actual, unique nature.

The predominance of a K state of mind, that is, of trying to get to know, as Bion pointed out, is required if we are to discover the truth about the nature of things, ourselves and others. It is as important an attitude for parents in relation to their baby as it is for therapists in relation to their patients. And yet past experiences, fears and ambitions tend to cloud and distort perception. Furthermore, the parents' own undigested anxieties and terror of them may stand in the way of being able to take those aspects of their child's mentality on board.

The present is founded in the past. This deeply affects the way the present is experienced, and, in turn, how the present is lived externally and internally holds within it the potential or barring of future possibilities. The questions the book constantly asks are: what promotes - and what gets in the way of - the development of the mind?

What leads to being stuck in a static state, incapable of blossoming, or worse still to taking a backward step from which we may not be able to extract ourselves? Is the arrest of mental-emotional growth of a temporary nature or is it more permanent, due to some external or internal event which puts a stop to or reverses development?

The nature  of relationships  which  assist  development  of the  individual and of those which tend to hinder is explored as we read about mother-baby, parent-child, the family, the school, the group, the institution. Each provides a setting in which the growing individual may he helped and  encouraged to come to grips with his experience, to learn from it, to use his imagination and inner resources creatively. On the other hand, it may be one that induces him to avoid painful exploration, to fit in, accomodate himself to a set formula, accumulate information, and pursue only outer success. But the other side of the equation: the child, adolescent, adult, being driven, through awful life events and inadequate provision of growth-promoting relationships, to continue projecting unwanted parts of himself (and thereby becoming highly disturbed and/or impoverished) is given equally detailed attention. What the author does not tackle is the question of whether and how far the individual has a choice in facing pain and bearing frustration, whether he seeks out in himself and others that which will help him in his struggle to find his place within this complicated, mysterious, infinite universe.

The way Margot Waddell writes about the joys and sorrows of being a baby, a child, an adolescent, an adult , a pregnant woman, a parent of children, adolescents, shows a great in-touchness on personal and clinical experience.

The difficulties individuals have to cope with in their external and internal worlds are related with deep compassion. Who cannot be moved by the description of Tommy, a boy of 3 who could not find a safe place anywhere? To be inside was experienced as being trapped in a terrifying place; to be outside was being a ‘scary thing', terrifying others and hence feeling unheld and falling to pieces. We are helped to understand Tommy through what emerged in therapy but also by hearing his mother’s story and feeling moved by her plight. She had not intended to have children because she thought of herself as 'bad and immature'. She discovered she was pregnant too late to have an abortion, was convinced she was carrying a monster within her, and after a horrific delivery was unable to breast-feed this ‘monster-baby’ and she fell into a state of deep and lasting depression.

To be able to enter with equal empathy into  the states of mind of mother and child requires wisdom and a balanced mind. But the still  greater feat that  Margot  accomplishes  is  that  she  is  able  to  be in touch with the whole spectrum of development, from conception to adulthood and ageing: I know of no other book which covers such a wide age range nor such a breadth of psychological phenomena. That in itself is an amazing achievement. The chapters take us through the chronological and psychosocial stages of development: beginnings in utero, infancy, early childhood, latency, puberty and early adolescence, mid-adolescence. late adolescence, the adult world, the later years. They are interspersed with chapters on models of learning and one on the family. The inner challenges of each period of outer growth of the person and his extending outer world are discussed.

The very first chapter, entitled 'States of mind', is of especial significance. For here we are introduced to the standpoint the author adopts. It is from the perspective of how life is experienced within the mind that all the different stages of life and development are viewed. It enables the author to jump forwards and backwards between the age groups, so that, for instance, within the chapter on infancy we learn not only about babies but also of an adult in treatment who cannot hold onto new experiences and is terrified of disintegrating at any separation; we hear that an adolescent state of mind might be found in an 8, 18 or 60-year-old; within the chapter on the adult world, we have an example of a boy of 21 able to behave as a calming, gentle mother when his mother is distraught. We also get to know how an 89 year-old lady temporarily found herself in the grip of Oedipal jealousy not dissimilar to that of a 3-year-old. I found these forward and backward links in terms of the inner experience an exciting as well as a useful way of looking at inner growth.

While certain mental states are shown to be characteristic of infancy, of childhood, of latency, of adolescence, of adulthood, we see that they can and do exist within bodies which are at a quite different stage of development. We all move to some extent in and out of thinking and feeling like babies, children and adolescents. The concern is only about those who get stuck and are unable to develop further. Sometimes their way of acting and speaking makes us aware of the discrepancy but with others, unless we know them intimately, from the inside, we may well be mistaken and assume their mental life to correspond to their chronological age.

Throughout the book the author is concerned to explore the nature of the internal and external relationships which sustain on-going growth of the mind, but it is in the three chapters on adolescence that the complexity of finding one's true and separate identity is discussed most fully. Many different ways of coping with the emotional upheaval at puberty, the anxieties aroused by having to come to terms with a physically mature body, with sexuality, gender, expanding social relationships, moving away from home and giving up infantile demands are described in detail. At the same time, the adolescent's struggles to become his own person, to integrate the different aspects of his personality also provide the author with the opportunity to draw together the themes of the previous chapters and to link them to the psychoanalytic concepts to which the reader has become attuned earlier in the book: the processes of introjection, projection and reintrojection; splitting and getting rid of unwanted parts; containment and transformation of anxiety; learning about as opposed to learning on the basis of emotional experience. Being capable of bearing uncertainty and nor knowing, introjecting the good qualities of maternal and paternal figures, taking back into the self what had been projected onto others - these are seen to be at the basis of integration and growth.

Margot Waddell writes beautifully. She communicates complex ideas with clarity, precision and simplicity while the liveliness of her style keeps one spell-bound. Poetry and quotations from novels as well as children's books further enrich the text, portraying the essence of the states of mind being discussed. The book can be read in a number of ways: as interesting stories of characters; as a help to parents, teachers and other professionals, providing insight into babies, children, adolescents,  adults  and  their  needs;  as  an  introduction  to  Kleinian, post-Kleinian object relations theory; as a quest for thoughtful introspection. I am sure it will be a most valuable textbook, on the reading list of training courses for analysts, psychotherapists and other helping professions - and a boon to those who teach on them.

The difficulty I have found in reviewing is that it is hard to adequately convey the scope, the richness, depth and literary beauty of this book.

References

Alvarez, A. (1992) Live Company. London: Routledge.


Bion, W. R. (1957) ‘Differentiation of the psychotic from the non-psychotic personalities’
                                        IJPA 38 (3 – 4)

Isca Wittenberg

 


 

Review by Angela Joyce

Journal of Infant Observation Nov 1999

This book is the sixth in the clinical series published by the Tavistock Clinic under the general editorship of Margot Waddell and Nicholas Temple. The series reflects the range of clinical and theoretical work which has been most influential at the Tavistock Clinic and this contribution is very much in the tradition for which the Tavistock has become well known, the Kleinian and post-Kleinian tradition. Waddell says that her aim is to ` illuminate not so much the developmental milestones [as] the growth of individual consciousness, so elusive a thing as development, the moral and emotional growth of the self, the character`. She also hopes to shed some light on post-Kleinian theories as she describes these processes. Margot Waddell is also known for her interest in and writing about  the relationship between psychoanalysis and literature[1]. This book is especially rich in references to, and uses of the Romantic tradition in English literature as applied to this aspect of psychoanalytic thinking about development. It is very much a book about morality; the good life or at least the sort of life which could be said to be making the best of what one is given. The text is beautifully written and engages the reader with ample clinical vignettes, and quotations and references to poetry and prose. The way Waddell writes certainly brings her theoretical thinking and clinical practice very vividly to life.

Although the book is arranged chronologically, from “beginnings” in prenatal life to “later years”, this belies the author`s thesis that states of mind transcend developmental phases and that they are capable of being experienced irrespective of age : “An adult`s state of mind may be found in the baby; an infant`s in the adolescent; a young child`s in the old man`s; a middle aged man`s in the latency boy”( page 8). By states of mind Waddell means those which prevail according to the classical Kleinian theory of “positions”- paranoid schizoid and depressive. They are said to exist from early infancy and to be available then throughout life.  The theory of positions rather than stages of development “constituted a significant shift within psychoanalytic understanding….away from the explaining and curing of discrete symptoms and towards one in which developmental possibilities are traced in the person as a whole, in relation to their prevailing mental states”. (page 6)

The use of a chronological  sequence in the book, suggests that the author does have a view that time and maturation play a part in the development of the personality. She does refer to different kinds of mental structures e.g. infantile and adult, which also suggests that time takes its toll, or alternatively ageing reaps its rewards; which brings me to the paradox of the book. States of mind exist in the body which is subject to the irreversible process of ageing. If states of mind transcend developmental phases then we must conclude that they do not incorporate the facts of physiological maturity and ageing. It could be said that the structures of mental states are not influenced by these facts, but their content may be. If that is the case, how can one talk about “growth of the personality” unless states of mind somehow embrace the uni-directional “arrow of time”, which  is based on  the irreversibility  of physical processes? Imagine trying to un-break an egg. According to the author the “later years” is the only  period in life  where age provides an “essential difference”, separating it out from other periods, and this to do with the reality of death which must be faced in one way or another.  Surely there are many “essential differences” throughout development which radically alter the impact of states of mind or indeed,  the experience of the external world. One such example is adolescence when the arrival of the sexually mature body  faces the individual with essentially different and new developmental tasks. Another  is young childhood, classically known as the anal phase, when control of one`s own body has immense consequences for self-experience as well as one`s relationship with the outside world.  It is this reader`s view that “the arrow of time” means that  work is constantly being demanded  of the mind  to take account of changes that ensue, consequent upon the developmental process. Too often in this book, there was a tendency  to express the developmental tasks of each phase as the paranoid schizoid -depressive position dilemma, and this could read  as very reductionist at times.

An aspect to Waddell`s account of development which I found refreshing was an implicit shift in Kleinian understanding of  development ( and also psychopathology) away from an entirely subjective account towards a more inter-subjective one. This  seems to be attributed to the influence of Bion and his theory of the “container-contained”, which is referred to throughout the book. However in my view, it is more Waddell`s own, as is demonstrable in the clinical vignettes  which are powerfully descriptive. Almost, if not all of her examples contain  elements in the history, of disruptions in the caretaking environment which are implied to be significant in the aetiology of the disturbance in development.  John Bowlby used to tell the tale of his supervision of his first child analytic case with Melanie Klein. The child`s mother was hospitalised following a psychotic breakdown and Bowlby apparently went along to his next supervision and relayed this to Mrs. Klein. She is purported to have said that this should be of no interest to him as a trainee child analyst; all he should be concerned with was the inner world of the child. Bowlby`s break with Klein, and his subsequent research into the effect upon development of real separations from primary caregivers, is now history. Waddell is reluctant to chronicle this shift in Kleinian clinical thinking as being in some way the result of the impact from other non-Kleinian traditions e.g. her claim that Mrs Klein “understood the utterly dependent infant….”  is actually a conflation of Winnicott with Klein. It was Winnicott who, in answering Klein, emphasised the absolute dependence of the infant at the beginning of life. This enabled him to have an inter-subjective account of development from the beginning, which was eschewed by the Kleinians. Indeed although the author does refer much to Winnicott in the text, it is as if his thinking was in the post Kleinian-Bion tradition, and this was not the case. Winnicott`s thinking about mothers and infants was very different from Bion`s. Winnicott`s emphasis on the “facilitating environment” set him apart from many other psychoanalytic  thinkers of his day, presaging the knowledge to be gained later about the impact of the caretaking environment upon development, from other disciplines such as developmental psychology.  Winnicott`s “holding” is not Bion`s “containment”.

It is  not for a critic to criticise an author for writing the book they have written  because they have not written the one  the critic would have liked to have done themselves.  However I do think that by confining herself to the Klein and post-Kleinian tradition, Waddell limits the scope of  her book unnecessarily.  In addition to the conflation of Winnicott with Klein, Waddell omits salient authors from other traditions within the psychoanalytic frame, a discussion of whose work would have fruitfully expanded this volume. Her chapter on adolescence is a case in point, where Klein is  said to be very largely responsible for the “ notion that adolescence [provides] a necessary period for restructuring of the personality” (p126) It is a pity that the seminal work of the Laufers on adolescence and the  requirement to incorporate the fact of the sexually mature body into the mind, is not referred to here.

I found this book  immensely stimulating, challenging me to examine my own biases and assumed truths, and always  a pleasure to read. I recommend it to all who have an interest in understanding the processes of human development from the inside.

     

Angela F. Joyce
Psychoanalyst & Infant Mental Health Psychotherapist.

 

The Anna Freud Centre,
21 Maresfield Gardens
London NW3.

 



[1] The Chamber of Maiden Thought.  M Waddell & M Harris Williams




 

Copyright © 2002 British Psychoanalytical Society & Institute of Psychoanalysis.

 


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