South African Psychiatry - February 2019

FEATURE
unseen corner of the mind. The baby attempts to live
in a state of bliss and preside over an omnipotent
objectless ‘imaginary heaven’ but, in truth, has
constructed a paranoid Kafka-like dominion though
introjection and projection with the return of the
projected and dislocation by objects in reality
imminent.
OF COURSE, IT IS JUST A MATTER OF TIME
BEFORE THE BLOW OF THE FALL FROM
GRACE INTO THE DISILLUSIONMENT
OF ACTUAL REALITY OCCURS. FAILING
THIS, THE BABY WILL BE ILL-EQUIPPED TO
ADAPT TO THE ORDINARY WORLD FROM
WHICH HE IS, AFTER ALL, NOT EXEMPT. AS
ESSENTIAL AS IT IS FOR THE INFANT TO
INITIALLY JUDGE FOR HIMSELF WHETHER
AN OBJECT OF SATISFACTION POSSESSES
THE GOOD, DESIRABLE ATTRIBUTE AND SO
DESERVES TO BE TAKEN INTO HIS EGO, IT
IS EQUALLY IMPORTANT FOR THE INFANT
TO REGISTER THAT THE OBJECT IS ‘OUTSIDE
OVER THERE’ SO THAT IT CAN BE SOUGHT
OUT WHENEVER IT IS NEEDED (FREUD,
1925). THE PLEASURE EGO CAN DO
NOTHING BUT WISH, WORK FOR A YIELD
OF PLEASURE AND AVOID UNPLEASURE
(FREUD, 1911). THE BABY HAS TO
LEARN TO USE HIS APPETITES, IMPULSES,
DESIRES, WISHES, NEEDS AND FEELINGS
TO LATCH, TO WORK, TO RETRIEVE THE
GOOD THAT IS ACTUALLY IN A WORLD
BEYOND OMNIPOTENT CONTROL. THIS
ORGANISES THE EGO AND ALLOWS LINKS
TO BE ESTABLISHED SO THAT THE OBJECTS
OF THE PSYCHE - REPRESENTATIONS -
CAN BE PRODUCED AND THE EXTERNAL
OBJECT CAN BE DISTINGUISHED FROM
THE PHENOMENOLOGICAL JUDGEMENT
OF IT. THE REALITY EGO CAN THEN
STRIVE FOR WHAT IS USEFUL WHILE
SAFEGUARDING THE EXPERIENCE OF
PLEASURE (FREUD, 1911).
How does this first developmental achievement
occur? “The baby,” writes Donald Winnicott (1945)
“has instinctual urges and predatory ideas. The
mother has a breast and the power to produce milk,
and the idea that she would like to be attacked by
a hungry baby. These two phenomena do not come
into relation with each other till the mother and child
live an experience with each other…I think of the
process as if two lines came from opposite directions,
liable to come near each other. If they overlap there
is a moment of illusion – a bit of experience which the
infant can take as either his hallucination or a thing
belonging to external reality” (p. 152). This requires
a particular type of environment: a caregiver who is
able to reduce the impingements of internal forces
and outside demands for the infant and facilitate
a manageable negotiation of reality and recovery
from collision with it over time (Winnicott, 1945, 1960,
1988). Green (1999) elaborates that in order to be
able to say yes to himself the baby must be able to
say no to the object. The mother must accept that
he can say no to her. And not only in the form of ‘you
are BAD’, but also ‘you don’t exist’. In other words,
states Green, the object must take the place of the
undifferentiated space in order to take in what is
spat out by the baby.
THE CARETAKER MUST NOT ONLY
ATTEMPT TO SPARE THE BABY EXCESSIVE
UNPLEASURE BUT CANNOT HAVE MORE
BELIEF IN THE BABY’S BADNESS THAN IN HER
OWN. THE NATURE OF THIS ENVIRONMENT
IS A SUBJECT DESERVING OF A PAPER
IN ITS OWN RIGHT PARTICULARLY IN
THE SOUTH AFRICAN CONTEXT WITH
THE LEGACY OF COLONIALISM AND
APARTHEID AND THE DESTRUCTIVE
IMPACT OF BOTH ON FAMILY BONDS AND
UNITS AND MATERNAL AND PATERNAL
FUNCTIONING.
However, in an ordinary environment the infant is
allowed the privilege of gradually taking a bit of
experience as a thing actually belonging to external
reality, that is, of refinding the object that was always
there which has already been incorporated by the
ego and convincing the self that it is still there even
though it belongs in the real world (Freud, 1925). This
is a critical emotional and psychological leap for
the baby as he begins to recognise and ‘re-cognise’
his dependence on external provision and objects
and the necessity of engaging with the unfairness,
arbitrariness, ordinariness and social contracts of a
big wide indifferent world. Freud (1925) states: “What
is not real, what is merely imagined or subjective, is
only internal; while on the other hand what is real
is also present externally” (p. 369). Re-discovering
the object and investing in it essentially equates
to committing to and engaging with reality in a
meaningful and relatively constant way with its
implied disillusionments and losses. This allows a
‘manageable distaste rather than a bitter hatred’ for
reality to develop. And, critically, mourning becomes
an inevitable part of life.
OF COURSE, AS WITH ALL THINGS
PSYCHOLOGICAL, THIS IS NOT SIMPLY
A MATTER OF ONE MOMENT IN TIME.
RENEGOTIATING A RELATIONSHIP WITH
REALITY IS AN ONGOING, LIFELONG TASK
WHICH MAY BE RE-EVOKED WITH EACH
DEVELOPMENTAL THRUST, CRITICAL
INCIDENT OR SIGNIFICANT RELATIONSHIP.
20 * SOUTH AFRICAN PSYCHIATRY ISSUE 18 2019