The article reviewed here is ‘Paediatrics and Childhood Neurosis’ by Donald Winnicott (1956). Winnicott begins by distinguishing the two meanings of neurosis – one understood by the general public at that time – ‘in popular speech it covers the whole subject of psychological disease’ before looking at the more specialised psychiatric meaning. He tells the reader that neurosis relates to the ‘unconscious conflict’ and that this in turn relates to the ‘instinctual life of the child’. Winnicott describes neurosis as an organised defence having several components.
1. In the first instance, the instincts are controlled so that only those that are acceptable are able to manifest themselves.
2. Winnicott then suggests that ‘obsessional rituals’ are used to overcome the ‘conflict of love and hate’.
3. The emotional conflict is converted into a conflict of physical functioning such as ‘hysterical paresis’
4. ‘Organised phobias’ allowing the child to avoid situations that provoke anxiety.
In treatment Winnicott advocates the use of supportive approaches to the parent-child relationship and the environment as necessary. He notes that symptoms can increase paradoxically when there is an improvement in the environment. Winnicott then tells the reader that intuition is not sufficient in itself for the treatment of neurosis and that there is a need to ‘take the psycho-analytical training’. Here he considers the future of paediatric psychoanalysis and how those with dual training in paediatrics and psychoanalysis should lead the way. He also warns against the expansion of psychoanalysis at the cost of training thus:-
‘I would rather see psycho-analysis held back for fifty years than witness a rapid extension of psychotherapy by those who have not studied the vast complexities of this subject and the human nature that it must go out to meet‘
This is one of Winnicott’s later articles which is brief but summarises his views on the childhood neurosis and it’s management in paediatrics. What is interesting here is that he has given due consideration to events that have not yet occured and continues to demonstrate his focus on working on highly abstract principles and then working these through into their effects in clinical practice.
Donald Winnicott. Paediatrics and Childhood Neurosis. pp316-321. Chapter XXVI. In D.W.Winnicott. Through Paediatrics to Psycho-Analysis. With an Introduction by M.Masud R.Khan. The International Psycho-Analytical Library. Edited by M.Masud R.Khan. The Hogarth Press and the Institute of Psycho-Analysis. 1978.
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