This is a 'preliminary personal statement' of Winnicott's theories on the emotional development of the infant during the first year of life based on his clinical experience with children and psychotic adults. Patients suffering from ambivalence can be treated along classical psychoanalytic lines; those with hypochondria and depression have a different fantasy about the analyst: instead of the analyst's work being done out of love it must be understood by the analyst as being done 'to some extent [as an effort] to cope with his … guilt and grief resultant from the destructive elements in his own (the analyst's) love. Finally 'the patient who is asking for help in regard to his primitive, predepressive relationship to objects needs his analyst to be able to see the analyst's undisplaced and co-incident love and hate of him'.
At about five or six months, the infant realizes for the first time that it has both an inside and an outside and assumes that its mother has an inside, and it begins to know itself and others as a whole. Before this time three processes start: (1) Integration and (2) personalization, (which occur together) followed by (3) realization (appreciation of time and space and other properties of reality). All of these processes are incomplete in psychosis.
Primaryunintegration is assumed; disintegration of the personality is well
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known. Integration is the feeling of wholeness and unity separate from the outside world and continuous through varying emotions. When integration is incomplete a series of dissociations arise. When day dreams are remembered and related to someone, dissociation is lessened.
'Contact with external or shared reality has to be made, by the infant's hallucinating and the world's presenting, with moments of illusion for the infant in which the two are taken by it to be identical, which they never in fact are.'
The primitive ruthlessness of the 'stage of preconcern' must be acted out in a child's play with its mother or it will have to get expression in a dissociated state.
Winnicott ends with a note on thumb sucking which he considers 'an attempt to localize the object (breast, etc.), to hold it halfway between in and out: a defense against loss of object in the external world or in the inside of the body. I should say, against loss of control over the object, which occurs in either case.'
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W., H. (1948). Primitive Emotional Development. Psychoanal. Q., 17:125-126