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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
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Child and
Family, Adolescent, and Adult
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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.

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Mirror to Nature:
Drama, Psychoanalysis and Society |
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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) |
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Facing it out: Disruptive
adolescents from a clinical perspective
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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) |
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Inside Lives -
Psychoanalysis and the Growth of the Personality
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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
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Waddell, Margot.
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Internal Landscapes and
Foreign Bodies: Eating Disorders and Other pat |
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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) |
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Reason and Passion: A
Celebration of the Work of Hanna Segal |
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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) |
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Psychoanalysis and
culture: A Kleinian perspective |
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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) |
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Multiple Voices:
Narrative in Systemic Family Psychotherapy |
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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) |
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Assessment in Child
Psychotherapy |
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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) |
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Psychotic States in
Children |
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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) |
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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.
PR and Marketing Enquiries:
Please contact Jo Leedham at j.Ieedham@karnacbooks.com
Trade Enquiries:
Please contact Halina Zebrak at trade@karnacbooks.com
Karnac Books
6 Pembroke Buildings
LONDON NWIO 6RE

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.
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.


Copyright
© 2002 British Psychoanalytical Society & Institute of
Psychoanalysis.

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