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The Story of Infant Development

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This book brings together the closely observed development of Simone (from birth to three) and the perceptive comments of Martha (or Mattie) Harris, who was such an influential figure in the development of the Observational Studies Course at the Tavistock. Romana Negri's pioneering work on neonatal intensive care units is informed both by infant observation and by psychoanalysis. She presents in this volume the transcribed tapes of her detailed observation of a normally developing infant, whom Martha Harris supervised for three years. Other chapters present observations of children in hospital that formed part of their diagnostic assessment, and the book includes commentaries by Donald Meltzer and Martha Harris together. This book will be of outstanding interest to all readers whether parents, teachers, or mental health professionals who wish to deepen their understanding of the roots of mental life.

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Chapter One: The Pattern of Normal Development: Forming a Relationship with the Breast

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The story of Simone starts with the mother's expressing her absolute need to tell the observer the intensity of the emotional experience of the birth, an experience that Mrs Harris defines as “stunning”. Simone in the first observation is in a state of restless sleep that Mrs Harris (following Mrs Bick) describes as “ordinary” or “normal” non-integration. In the following sessions we see how this is modified and overcome, when the nipple through the force of its attraction pulls together the functioning of the baby's eyes and mouth and starts the process of integration. The sessions in this first period demonstrate how for the mother the overwhelming impact of the birth is followed by the emergence of depressive anxiety relating to her uncertainty about her capacity to nurture the baby and to take on a genuinely maternal role. For this reason the mother maintains a certain distance from the baby that interferes initially with the process of the baby's introjection of the object.

A stunning experience

 

Chapter Two: The Pattern of Normal Development: The End of Breastfeeding

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Weaning is accompanied by the emergence of particularly painful feelings in the baby, which bring out infantile elements in the surrounding adults that in turn disturb the baby. This is shown in the account of a visit of a friend of the family. The experience of the loss of the breast induces feelings of rage in the baby that result in aggressive behaviour. The intensity of feeling is such that to spare his mother he attacks instead an inflatable toy cow. To relieve his violent feelings Simone seeks an alliance with an older child. Of particular interest is the twelfth session, in which Simone shows how, through evolving representations of the breast, he internalizes the object.

The end of breastfeeding and the underlying feelings of the adults surrounding the child

Tenth observation of Simone, age six months, thirteen days

RN (reads): Simone is on the patio in his pushchair with his mother, looking at the small children playing in the garden. He looks at me intently, putting his hand in his mouth and stretching out his arms. He rubs his fingers and looks intently at a male friend I met in the garden and who is speaking to me. He takes hold of a little bell, brings it to his mouth, kicks his legs.

 

Chapter Three: The Story of the Birth of the Next Sibling

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Around two years old Simone learns that his mother is expecting another baby. This produces in the life of the child a change that one could define as “catastrophic” (in the terms of Bion). Emotions of peculiar intensity trigger multiple attempts to find ways of tolerating the pain. We see him exploring various identifications, both masculine and feminine—with his farmer grandfather and his hat, cows and the birth of piglets, and his shotgun. He identifies with the mother who has a baby in her tummy. Mrs Harris brings out very clearly how Simone's curiosity about the baby stimulates his epistemophilic instinct. The importance of stories at critical moments of a child's life is very evident: how they allow the emotional experience to come to life in a poetic and imaginative way that can contain intense and baffling emotions.

Feminine and masculine qualities

Nineteenth observation of Simone, age two years, one month, and ten days

RN (reads): I call at Mrs P's house on the 4th December in the morning, but there is no one at home. I go to find the father in his pharmacy; he tells me he is worried about his son because of the coming baby. Lately, Simone has often “telephoned” his grandfather in the country and asked him how the piglets are, and if the calf is born. (The other day, he had heard his mother talking to her father on the phone about a cow that was due to calve.) Ten days ago, Simone had again had difficult problems during the night. Yesterday, when he heard his parents talking about the new baby, he said spontaneously that he would have put him in his tummy. Last night, Simone slept in his parents’ bed. At one point, early in the morning, the mother asked her husband to touch her tummy to feel the baby's movements. When the father moved to do this, he jostled against Simone, who immediately transferred himself from the bottom of the bed where he was, to a position in between his father and mother.

 

Chapter Four: A Three-Year-Old uses the Gang as Container

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This case is of particular interest since it provides an opportunity to observe the containing function of the gang in a child as young as three years of age. It demonstrates the difference between the defensive qualities of the gang as “second skin” and somatic symptoms. In the fourth session, the parents’ unfulfilled childhood becomes apparent.

Introduction and summary of first two observations 2

When talking to Mrs Harris about young-child observation, I explained the difficulties that arose as a result of my work not giving me the opportunity to often visit nursery schools. Then it occurred to me that I might be able to observe a young child who was recovering from a physical illness in the paediatric department of the hospital where I worked as a consultant, and where parents are allowed to stay with their children. Mrs Harris said this was a good idea, and I then made inquiries about the 2–3 year old children who were in hospital. I excluded one who was in the isolation ward with an infectious illness because I wished to make the first observation in a room with other children present; and I chose Angelo D because his home was near the hospital. As I walked with my colleague down the corridor towards the day-room to find his mother, my colleague called to her and she came out. She was young, pretty, and sensitive in expression. While I was explaining what I wished to do, a small child emerged from the day-room and came up to her; I realized this was Angelo, a well-coordinated, generally fine-featured child, though with a slightly broadened mouth and nose. His olive complexion and light chestnut silky hair enhance his deep dark eyes. He was three years and two months old.

 

Chapter Five: Play Observation in a Hospital Setting: Some Diagnostic Implications

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The work recorded in this chapter was carried out by Martha Harris with doctors from the Institute of Infant Neuropsychiatry at the University of Milan between 1970 and 1973.1 There are three cases of play observation which were conducted in the hospital by Romana Negri and (in one case) by Laura Musetti; followed by two infant observations which were presented for supervision in the context of the same clinical group. Each of the children in play observation had posed particular problems in terms of diagnostic evaluation.

In psychiatric practice, above all in infant neuropsychiatry, it is quite frequent to encounter symptoms which do not conform unequivocally to any single diagnostic picture but which may belong to quite different and distinct clinical situations. In considering a child's inhibitions, for example, we need to judge whether psychotic or neurotic elements are dominant. The various psychical tests and instrumental examinations used in the traditional clinical approach do not always permit this type of differentiation, so it often happens that the neuropsychiatrist is drawn into abstract theorization, without necessarily realizing it, and so loses sight of the concrete elements that define the meaning of that particular case.

 

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