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Sterba, E. (1936). An Abnormal Child. Psychoanal Q., 5:560-600.
(1936). Psychoanalytic Quarterly, 5:560-600
An Abnormal Child
That Herbert surpassed the average mental development of children of a like age is an incontestable fact. According to the Binet-Simon test, the child was on the average three and a half to four years ahead of his age. The justification for considering his early intellectual development, at least tentatively, in a separate category from his mental illness, is based on the fact that this early intellectual development occurred first without a sign of his illness.
An insatiable thirst for knowledge such as appeared in this child simultaneously with his mastery of speech, has been observed with otherwise normal infant prodigies. Like Herbert, these children also, at least in whatever came within the scope of their unusual talent, exhibited an inordinate self overestimation. Although in all the biographies of early geniuses, traits and qualities are found which are identical with many of those which were observable in this case, nevertheless, there seems to be an essential difference between the talent of the infant prodigy and Herbert's intellectual precocity. The performance of all infant prodigies has occurred in a specific easily demarcated sphere. Many of them showed childish traits and retardations in development. Herbert's early intellectual development appears to have had a different character. There was no special field where his precocity appeared as extraordinary as it does in the case of infant prodigies whose performance is exceptional and far surpasses the average level of the adult. Herbert's development in the intellectual sphere was of a general nature. It appeared as if, at twenty-two months of age, he had endeavored to be an adult. His mathematical talent although far above the average, was not to be compared with that of a chess genius. Some quite extraordinary talent in some specific field in spite of his illness would have to be demonstrated to consider him a child prodigy. His literary production may be considered merely as a product
of his universal mental precocity rather than as the first sign of a literary talent, although of course all prognostication over the further development of his talents must remain very uncertain. Between the quality of his intellectual maturity, and the type of his illness there is a very far-reaching connection, at which one can merely hint. Perhaps the proofs may be deduced from the summary of his libidinal development as it appeared in the frame-work of the analytical treatment.
His linguistic talent does not fall, perhaps, quite within the scope of general intellectual precocity, because properly speaking, Herbert never acquired the language of a child but began at once to speak correctly. In other respects, his intellectual development was parallel. He walked without first learning to creep; he could read without any observable effort to learn; he could write without having had to practice it. There emerges here a new problem. How was Herbert able directly to achieve all these purely intellectual feats? The unusual quality of his genius may lie, perhaps, in just this faculty of acquiring mental knowledge without preliminary training, which may have to be accounted for by the fact that he possessed a peculiar propensity in this direction which is incapable of further explanation. There appears to be present in his speech, a faculty for formal presentation which is far above the average. Everything he said was in a sense verbally perfect, and it could not be said that the form of his sentences was borrowed from books, for his reading which was confined mostly to dictionaries and calendars, could not possibly have helped to form his style. It is difficult to procure comparative material from unusually speech-talented children, or from the biographies of poets at the same age level. There is little such material available, and when one comes across childhood sayings in a poet's biography, one is never certain that such sayings are cited literally.
As already mentioned, when Herbert was brought to the analysis, he used only the infinitive of verbs, avoiding the pronouns I and you. C. and W. Stern in their book, Die Kindersprache, have reported that their little daughter, at the
age of twenty months, employed the infinitive only, and the use of I and you first developed at the age of twenty-five months. One might venture to suppose that Herbert had regressed to an earlier stage of speechdevelopment. His parents, if we may believe what they say, had never observed such a stage in his development. Perhaps the period of normal speech acquisition passed so quickly that no such observation was possible. In contrast to the speechdevelopment of other children, which begins with the imitation of sounds, Herbert showed always a disinclination to onomatopoeia. When he had been asked to copy a story about a fire company in which the expression trara appeared, he had objected strongly to this word. "I can't write that. That is childish. You can't copy sounds. Sounds are really not words." For a time he could not be brought to read names of certain animals such as lion, tiger, dog, "because they make sounds which are not words".
Some of his peculiarities of speech which may be observed in the speechdevelopment of average children, appeared in his speech at a different time level. Such remarkable combinations as, "That is the water-door because one goes through it to the water-main"; or "the workshop (occupational therapy) is thursdayish because it occurs on Thursday", are very reminiscent of C. and W. Stern's collected word-combinations of their children, which, however, fall within the period of from two and a half to five years of age. Such word-combinations of other children all originated at a time when the speechdevelopment was not yet ended. They are, therefore, a constituent part of their speechdevelopment, whereas with Herbert these verbal combinations belong to a period long after he had completed his speechdevelopment. Considering his unintelligible expressions as original word-formations one discovers that a connection with colloquial speech may always be established. There are to be found in his history, no
authentic original creations. Stern and other investigators of children's speech have proved that during the period of speechdevelopment these are never observed. Herbert's first unintelligible words, lan, len, lin, lün, lein, are etymologically only to be taken as a stringing together of syllables with different vowels, which is so popular among children. What is remarkable, is that these words were used to characterize objects during a period in which speech was already fully developed. The word floda might have had its origin in the exclamation ein Floh ist da! Flau may have originated by analogy, and the same is true of flaudele. The etymologies of Roche, Toche, Foche, appear to be sufficiently covered by the word Toches (Yiddish for buttocks), and the Viennese expression Fotz (female genitals). All other neologisms contain a preponderance of u and i sounds, always employed in the same sequence. They are constructed in the same way as Potju and Bubilu. From Potju, in an analogous manner, might have been constructed Jejuju (keyhole), futju (being excited), tuju (darling or loving), schluju (to administer an enema), Kindju and Vatju. Similarly formed from Bubilu, would be Klufterierpfuffi (penis), Bluftili, Wuftili, Fudili (nipples), Wudi (orange seeds), Pruicht (the evil one), and Kruich (female genitals). Although Herbert as a rule rejected onomatopoeia because "sounds are not words", with certain words one has to presuppose that there is a reminiscence of onomatopoeia. For example, Klufterierpfuffi suggests pf, pf, and Schluju (an enema).
Such punning as "I can't eat whipped cream, for then I will be whipped", is frequently encountered in children. Stern observed a similar tendency in his daughter. She would ask, "Do nightingales make night?" At that time she was three years and nine months old, and obviously did not yet understand the meaning of the word nightingale. Herbert knew the meaning of all the words he used. At times he chose to ignore their meaning for a specific reason. There are some
important parallels to the speech disturbances of schizophrenics, which cannot be gone into in this article.
This child had been brought for treatment with the diagnosis of an infantile psychosis, and the recommendation that he be sent to an institution. He was completely subject to numerous phobias, rituals and prohibitions which he had explicitly to observe, defensive measures against every kind of medical attention, he showed an insupportable restlessness, attitudes approaching delusions of grandeur, a total lack of contact with surroundings with absence of any feeling, and completely unintelligible speech, all of which made living with him at this period very nearly impossible.
The first step in the treatment was the establishment of a contact with the analyst. Next to be observed, was a certain interest in his environment. For the first time, he spoke normal sentences, he began to use personal pronouns, it became possible to give him medical attention, and the delusions of grandeur were reduced. He no longer had to preserve the illusion that he was an adult practicing a profession to be able to exist.
During the next phase of the treatment two very widespread phobias disappeared, the fear of keyholes, and the fear of the "squirting lattice". His fundamental attitudes towards his parents and his brother emerged, he developed an increasing attachment for the analyst and for his kindergarten teacher, his self overestimation was further reduced, but his fear of speaking proper names, and of naming parts of the body remained.
The latest period of the analysis here reported attacked the problem presented by his expressed wish to remain fearful. He managed finally to speak proper names and names of the parts of the body, and in general he was changed so much for the better that he could go to school, and be placed in a children's home. Physically, he was much stronger, and his appearance had become significantly more normal. He underwent operations on the ear, nose, and throat, without the slightest relapse to the original condition of his illness. His
behavior at home was a little improved although his earnest endeavors to establish a more cordial relationship with his mother and his brothers met only with disappointment. Consequently, he was all the more attached both to his teachers and to the analyst, and his behavior in the family which lodged him during a summer was entirely normal. With children of his own age he now formed some sort of a superficial relationship. He succeeded in his studies at school, in spite of his refusal to adapt himself to the curriculum. His quest for knowledge remained totally unchanged, with the exception that he was no longer so querulous and disturbing, and he was much more reasonably selective in his interests. He was less awkward, but any instruction requiring manual dexterity he rejected as "a stupid imitation". He had given up the use of all unintelligible words. His talent for expressing himself in words and for calculating endured, although they were no longer so striking and abnormal as formerly. In spite of this great progress Herbert could not be said to be a normal child; he was still too conspicuously introverted from time to time. When he was buried in a book or lost in his thoughts, one found it difficult to engage his attention. But very often he was interested in everything, laughed and played as would an ordinary child, or else he was ironic and witty in the manner of an adult. This last began to develop in the most recent period of the treatment and steadily increased. Thus when he had been reproached for the long time which he took to dress, saying, "You need five minutes for each overshoe", he had replied with a laugh, "What are five minutes to eternity?" He could now, like other children his age, take care of his needs, wash, and dress himself. But at times his tendency to introversion prevented him from accomplishing this. Similarly, for a while, he would make no objection to eating the food given him, but then again he would refuse certain dishes. He took longer to eat than other children because of his bad teeth and because, especially while eating, he became greatly self-absorbed. One might say that he was able to forego all his fears, prohibitions, and rituals when he was not exploiting them to obtain something.
In tracing his libidinal development, one is first impressed by the extraordinary difficulty encountered in his weaning. The violence with which he rejected all other forms of nourishment which were placed before him, allows one to assume the presence of an unusually strong oral constitution. Taking into consideration the extent to which the younger brother was utterly spoiled by his mother, one may safely infer that during Herbert's infancy, his mother had done everything imaginable to indulge him orally. Everything known of his development after weaning, is in accord with a tenacious clinging to his oral pleasure. The feeding problem began immediately, and increased as time went on. Furthermore, one finds in him from the earliest age all the characteristics of the oral type. He began to talk extremely early, and his speechdevelopment was accomplished in an unusually short time. He showed an abnormal urge to know, would have liked impatiently to swallow up everything which furnished him with knowledge, to suck in everything in his environment. He was insatiable in this demand; his craving for knowledge knew no limitation. It seemed as if the restlessness with which he pursued his intellectual interests were a proof that his abnormal mental development had absorbed all the available energy, so that nothing was left over for the creation of normal object-relationships, displaying no feelings, and never demanding affection, indicating a marked fixation at the autoreotic level. He had kissed and caressed himself. His strong autoerotism, on the other hand, may have intensified the effect of the frustration which the retarded weaning had occasioned, and thus have checked the establishment of object-relationships.
It may certainly be said that Herbert exhibited a special fixation to the second stage of oral erotism, the level of pleasure in biting. One will recall in this connection the importance to him of nipples, his anxiety of being bitten by the Wudis (orange seeds, nipples), with the consequence that he could only suck out the orange, an anxiety that was a defense against
his desire to bite. His oral sadism was distinctly expressed in his very first words in the analysis, "Everyone is choked".
In the period in which Herbert should have begun to develop normal attachments, he experienced three severe traumata: the birth of his brother, painful treatment for otitis media which he was forced to endure for months, and an attempted seduction by a maid servant. His parents made the observation that his mental illness steadily increased following this period. There is a connection between these traumatic events and the character of his illness. All of his symptoms,—his unintelligible words, the compulsions, his delusions of grandeur, his refusal of every kind of medical attention, his fear of speaking names and parts of the body, his anxiety about keyholes and the "squiring lattice",—serve the one purpose of protecting him against the repetition of these three frightful experiences. The fantasy that he was an adult with a profession also had the purpose of avoiding the dangers which threatened him as a child. He kept all doctors away, in order to prevent them from hurting him as they had done when they treated his ear. His refusal to eat was a repetition of his reaction to the trauma of weaning. His disinclination for everything that was new sprang from a desire to stick to whatever had been proven safe. His desire to know and understand everything concealed behind the oral greed an apprehension that whatever was unknown might constitute a menace.
His peculiarities of speech were defensive measures against the anxiety aroused by his traumatic experiences, and they originated as a protection against their repetition. He did not give the strap in the trolley car its proper name because he could not admit that he was a child unable, on account of his small stature, to reach it. Sequences of unintelligible words all of which represented things taboo, were found for the greater part to have originated through analogy to two pet names which his mother had called him, when he was still the only child. The use of these unintelligible words signified a
retreat to a period preceding the terrifying traumas, a period in which no injury had as yet befallen him. Many of the other peculiarities of his speech, such as the exclusive use of the infinitive, the avoidance of certain personal pronouns, odd combinations, which in his case, in contrast to other children, were found only after the developmental period of speech had come to an end, are to be viewed as a flight to the happy time in which he was a suckling, beloved and spoiled by his mother. He had begun to talk when he was nine months old, and at fourteen months the developmental period of his speech may be regarded as having come to an end. At eleven months he had been weaned. Through the revival of certain peculiarities belonging to the developmental period of his speech, he repeatedly experienced the pleasure belonging to the period in which these imperfections first made their appearance. No one had observed them because he had learned so quickly to talk.
Deriving also from the influence of his strong oral fixation was his firm conviction in the magical power of the spoken word to alter reality. Simply to state that he was a shopkeeper, made him one. Naming a part of his body would make it vulnerable; to speak a person's name might cause him to become transformed into that person; if he were to speak the word, girl, he might become castrated like a girl. Similarly, he could not walk by a perfume shop, because of his conviction that it had squirted at him. His inner realities had for him greater force than external reality, and he strove to impose this inner reality of his upon those with whom he came into contact.
It is known that primitive peoples have prohibitions which forbid the speaking of a certain name because, if it were uttered, some inauspicious event fraught with danger would follow. With children, also, there is a period in which they believe in the omnipotence of their wishes, gestures, and words. Following its birth, there is an attempt on the part of those who take care of the infant to approximate the condition prior to birth where it was in need of nothing, and this
is done by anticipating the infant's every need. Every expression of a need is followed by its immediate fulfilment. The child soon recognizes this sequence and deems the utterance of its wishes to be invested with sufficient power to bring about their satisfaction. It has sufficient cause to believe in its omnipotence. When it learns to talk, the feeling of omnipotence is transferred from the previous physical expressions of its needs, to words. Ferenczi has described this phase of the period of magic omnipotence of words.
The beginning of this period of the magical omnipotence of words, must fall naturally in Herbert's development in the period of his speechdevelopment. He had, moreover, particular reason for being convinced of the omnipotence of his words, for through words he had succeeded in attaining the continuation of the suckling's almost completely satisfied condition. He had begun to talk at nine months, and nursing was continued at his demand until he was eleven months old. One might for this reason assume a special fixation to the period of omnipotence of his words which was in turn strengthened by virtue of his oral fixation.
The form of his aggression also showed his fixation to the stage of magical omnipotence of words. He seldom attacked physically his brother whom he threatened verbally with cutting off his Roche. His strongest, affect-laden aggressions were imprecations. By crying out a hundred times, Tetschen, Fotzen, Watschen, he inflicted all these blows through the mere power of his cries. His mother had, in fact, threatened that he would be turned into a sewer-cleaner if he used the word for filth. There is no doubt that his continuous efforts to be grown-up and big and to have a profession, his rejection of everything childish and his opposition to the very use of the word "child", are all results of the severe disappointments which as child he had really endured.
Another sign of his imperfect adaptation to external reality
was the lack of his connection of the meaning of a word, to the thing itself, which was conspicuous at times when he had reason to deny reality, in situations in which he felt himself endangered or which were preceded by events which incurred the threat of danger. Also the abundant symbolism in his speech and actions seems to be further proof of his failure to achieve object relationships. When he had handed an object to a teacher who was in a receptive, passive position, it had had for him the meaning of an act of sexual intercourse (the test material for touching, in the Montessori school); when he had stamped on the floor, it had meant producing children. The foot was the symbolic penis with which he stamped a hole in the earth out of which the children were drawn (his stamping on the ground during the illness of his little friend).
It seems justifiable to conclude that there is an essential difference between a childhood neurosis and Herbert's illness. However, as the theoretic considerations from the analysis of this case will be deferred to a subsequent paper, the author will here summarize the difference briefly. Despite his unusual intellectual maturity, Herbert's illness consists in his adhering to an extremely early stage of ego development in his relation to reality. To be sure, certain constituents of his ego have developed a relation to reality, but they are in the minority, and the chief components of his personality have remained retarded partly as a consequence of the severe traumata, and partly also on account of his pathological self-love and his strong oral fixation. Because of this defective reality testing, his conviction that reality consists in what he asserts and imagines, make it justifiable to conclude that his illness was a psychosis rather than a neurosis. This distinction lies in the fact that with a neuroticchild, one who has a dog phobia, for example, the symptoms are expressed in such a way that the fear of dogs is found to develop from inner conflicts, whereas with Herbert, in consequence of the frustrations and injuries which he had suffered, the picture of reality itself had undergone alteration in such a way as to protect him against all dangers.
The difference between his illness and the psychosis of an
adult may be formulated in the following manner. The essential characteristic of an adult psychosis is the loss of contact with reality, whereas in this child one finds rather a failure to acquire any such relationships at all. That is to say, it is primarily the factor of regression which distinguishes Herbert's illness from the psychosis of an adult.
There is an objection which the reader might be prompted to raise. One might be inclined to regard the protective mechanisms, which are compulsive in character, as symptoms of a compulsionneurosis. This is supported by abundant evidence of a strong anal sadism. He wanted to stick his finger into his brother's anus, to give him an enema, and then, on account of his own libidinal wishes was in turn himself afraid of enemas. But apart from the general weakness of his object relationships and the fact that most of his sadistic aggressions were encountered on the oral level, there is another essential difference from a compulsionneurosis, and that is the fact that he devised all his protective measures consciously, employed substitute words in order to escape the dangers which his verbal expressions might involve, and did not speak other words because he knew exactly the dangers which would best him, and was firmly convinced that these dangers would materialize; so firmly convinced, in fact, that he altered the outer world to suit himself in order to escape a repetition of these dangers. The compulsive neurotic, on the contrary, is not conscious of the reasons for which he carries out his compulsive act. It is true that he believes that something dreadful might happen, but he is not aware of all the antecedent events which have set this compulsion in motion. It is only during analysis that all this can be made conscious to him and brought into its proper connections.
On all occasions his fears of an injury to his entire person was much greater than the fear of an injury to his genitals. Even though he was afraid of losing his Klufterierpfuffi (his penis) and of becoming a girl, that is to say he showed what one commonly calls castrationanxiety, the author attributes a secondary importance to this anxiety, because the fear of injury to his
entire person was ever present. When he was masturbating in the children's home without any sense of shame he still continued to defend himself against all medical treatment. Likewise the anxiety of the "squirting lattice" disappeared completely only when it had been brought into proper connection with his experiences at the children's clinic, with the crib and its railing and the enforced douching which recalled to his mind the ear treatments. Attention is called to how crude, direct, and uninhibited by shame were the expressions of his sexual activities, and that this is an argument against his fear of being punished for these activities to any unusual degree. This fact falls into the category of his remarkable precocity and desire for universal knowledge. He knew everything, requested the school teacher to have coitus with him, was familiar with how a penis functions, but the next moment on seeing a new book, he was completely indifferent to such things. His attitude towards sexual knowledge was charged with no greater affect than to any other topic, and he never became so excited when masturbating or beingfutju, as on those occasions when he was able to learn something new.
Corresponding to the difference in form of his illness from that of the ordinary neurosis of childhood, the treatment had to have a different aim. It was not a question here of discovering and making conscious and intelligible the unconscious, but rather of permitting him to make up for his deficient contact with reality, to educate him, so to speak, to a normal sense of reality. The analyst succeeded first by participating in his delusional ideas, and by understanding them, came to occupy a position in his omnipotent magic world corresponding to his demand for a protector equipped with magical power. From this position of advantage, which for him betokened the most important relationship to an object in the outer world, she began gradually to confront him with reality, and, while affording him protection by her enchantment, to show him again and again, and to prove to him the unreality of his affirmations. It is unnecessary to emphasize that such a procedure was possible only on the basis of an acquired understanding of the
protective function of his delusional ideas, and that it required the most careful dosage in order to maintain his attachment to her in spite of her encroachments. At the same time she gave him as far as possible the opportunity actively to work off the sufferings he had passively endured, as for instance, by drawings in which the devil made off with the doctors. It can not be said that the explanations given him were interpretations in the narrower sense of the word. He needed usually only a hint which he elaborated at once into an exhaustive and penetrating explanation of the psychological situation that was under discussion, so that it was not necessary to interpret.
The changes which were accomplished in this treatment together with the displacements in energy which brought them about, were realized through the acquisition of a sense of reality, and by the extension and deepening of the child's relationship to the outer world, and to human beings. This furnished him with the further possibility, based on an identification with the analyst, and protected through the belief in her magical power, of assuring himself of the relative harmlessness of the outer world. In the beginning his attachment to the analyst could still not be characterized as normal on account of the position which she had occupied from the start in his reality-denying system. It was only in the last phase of the treatment described, that one finds traces of object-libido, such for instance as his jealousy, and his interest in her private life.
With the strengthening of his object-relationships his libidinal orientation also underwent an alteration. He was freed in part from his oral fixation. One sees from the persistent strong urge to know, from the overemphasis of everything verbal, and from his continual difficulties in eating, that the oral component still remains in the foreground. How far he will still be able to overcome this fixation, the future will disclose.
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