Psychoanalytic Treatment: Is Winnicott Good For Piggle - Case Study Example

Is Winnicott Good For Piggle "The Piggle" is an account of a child psychoanalysis which was written by David Winnicott, in 1977, and has been republished many times. The Piggle in question is a two year old called Gabrielle, part of a family who have recently experienced the birth of a second daughter. Piggle saw Winnicott in a series of occasions, sixteen in all, until she reached the age of five. Winnicott wrote about these sessions, and included some notes and messages from the parents which gave details of Gabrielle at home. Winnicott was an expert child analyst who ran a busy and well-known practice in England. At the time of the beginning of the writing, he was in his late 60's. Despite this, and the rather difficult demands which travelling to see the doctor placed on Piggle and her parents, the patient herself often demanded to see the doctor, and from an early fate, she talked to him (and he to her) as though Winnicott was a familiar part of the family; Winnicott himself described the parent's visits, and Gabrielle's later insistence on seeing him, as "Psychoanalysis on Demand" (Winnicott, 1991 page XV). This treatment system is relies upon the patient's own demands for help, as and when it is required by them. Winnicott also noted the problems with this system, particularly where the patient cannot be accommodated: When within this framework treatment cannot take place when Demandedthere can be very violent repercussions, and as It may seem in this case, very narrowly avoided inner disaster for the patient (Winnicott, 1991, page 200). The difficulties of being available to the patient, while not simply a puppet to be called on a whim, may present and interesting dilemma, as the system does depend on the whims of the patient, but Winnicott felt that this was a better solution to the needs of the patient than a weekly session "of doubtful value, falling between the two stools and preventing really deep work from being done" (Winnicott, 1991, page 3). The progress of Winnicott's treatment of Gabrielle, with an apparently happy outcome is a very interesting tale from a psychoanalytical perspective. Firstly, Winnicott did not see Gabrielle in a series of fixed sessions, but according to Gabrielle's own desires, and Winnicott describes their last session as "More like a visit from a friend to a friend" (Winnicott, 1991, page 195). Secondly, the treatment appeared to satisfy the parents, who received back the child they had seemingly lost; and Gabrielle herself seemed very satisfied with the treatment, and the troubles which she had had at the beginning were apparently ended through the analysis. This, of course, was not a course proscribed by the doctor; indeed, three years seems a very much longer period than that taken by Freud in the treatment of his patients; and no-one would suggest that the return-visit by Dora, for example, was the visiting of a friend to a friend. The gradual development of the girl, from someone who clearly exhibited a number of anxiety responses, including bad dreams and depression, to a schoolgirl who was seen at the age of 5 as very happy, at age 8 as 'very competent at her work" (Winnicott, page 200), and with what were seen as proper feminine ambitions: to be a teacher, to grow plants; however, and her parents consider that Her inner independence of judgement, and also perhaps a way Of being in touch with people on many wave-lengths, make Me wonder whether thesatisfying experience of being Understood on a deep level may not be continuing. (Winnicott, page 200). However, her conceptions about what were actually happening in the analysis may not have been that of an adult patient; Gabrielle clearly did not feel "Under Analysis", instead, she described her visits to the doctor as occurring when he was writing his autobiography, and that "He used to write and I used to play" (Winnicott, page 201). It may be an interesting question to consider whether the child benefited so much from psychoanalysis as the chance to play and talk away from her parents and new sibling. However it occurred, it could be seen that the Piggle did benefit from the sessions in some way, and that the parents were also relieved by this. Beginnings The parents contacted Dr Winnicott in the early winter of 1964, concerned by their daughter, who had apparently gone from a happy child who "Hardly ever cried" (Winnicott, page 5), to one who Becomes easily bored and depressedand is suddenly very conscious Of her relationships.overt jealous of her sisterShe has become very Obviously reserved toward her father. (Winnicott, page 6). Those symptoms are, of course, very interesting from a psychoanalytic point of view, and were accompanied by dreams of a "Black mummy" who pulls out her breasts, and then puts Gabrielle in the toilet. The black mummy, who lives in her tummy, and who can be talked To there on the telephone, is often ill, and difficult to make better (Winnicott, page 6-7). This Black Mummy is clearly, as shown in the analysis, both a representation of Gabrielle's mother, and of the child herself. The fact that the Black Mummy often refers to her breasts, and then puts her in the toilet would no doubt have pleased Melanie Klein a great deal; the idea of the bad mummy with poisoned breasts, who is associated with faecal waste, or 'the toilet', is almost text-book a description of the childish Death Drive, with the good breast and bad breast, although the Piggle is at a later age. The Black mummy was associated with another nightmare, known as 'The Babacar'; which both mystified the parents, and caused Gabrielle some unhappiness: Earlier agony of tension that she had about the black mummy and The babacar until "Something snapped" as it were. The mother did Not know the exact origin of the babacar, but it was linked with the Black mummy, black self, and black peopleThis is consistent With the idea that black here meant that hate had come in. (Winnicott, page 15). Winnicott here is seeing the Babacar and the Black mummy as threatening aspects of the Piggle's own psyche; these nightmares represent the dark thoughts which had entered into the Piggle's emotional world with the birth of her baby sister. However, the black mummy is also one that needs to be taken care of; she is often unwell, and the Piggle must nurture her. Here we can see that the hate and love positions are together in the Piggle's mind, and cannot be separated. Piggle has perhaps realised that she both loves and hates parts of her real mother. Winnicott ties the Black mother's illness (Falling), to the recent birth of the sister: Of the hate and love of the mother appearing simultaneously, and Of the Piggle's ability to use the mother aggressively. To this one Must be able to add the question: falling is becoming pregnant. In This way, the father's aggression is included. (Winnicott, page 16). Winnicott sees these nightmares as the symptoms of madness (He does not mean the Piggle is mad, I hope, but that her symptoms can be analysed as comparative with the psychotic phantasies of insane adults). As well as all of the Piggle's psychological complaints, it might be fair to comment that the parents were uncomfortable with the changes in their daughter (From idealised infant who did not cry to frequently upset, and often fussing, child), and that this discomfort, which is clearly expressed in the letters to Winnicott, may have been feeding back into the Piggle, so that she has become associated with the Black Mummy - she is not the good daughter they once had, but the 'black piggle', who is sometimes nightmarish to her parents, and also requires more 'care' (Note that Gabrielle is reported as falling more often than she used, and demands to be cared for when this happens, this is very close to the 'falling' of the black or nightmarish mummy). It is not impossible to suggest, then, that the parents are in some way responsible for the intensity of the Piggle's feelings. Treatment After this first session, the Piggle seemed to become rather dependant upon the Doctor Winnicott figure, often demanding to be taken to Dr W. However, one can see also that the parents have seen some improvement in the Piggle (Whether real or imagined) since she has seen the doctor. Again, this suggests that the parents are somehow influencing the Piggle with their own expectations. It is also possible to suspect that the original idea to have their child treated was the parent's, and one can perhaps see in their expectations a similar request to that made by Dora's father: to "Bring her to reason". After the first, rather mild session, Winnicott begins to ask questions of the Piggle: one such exchange concerning the filling of a toy bucket to overflowing: I interpreted this was being sick Me: Winnicott is the Piggle's baby: its very greedy because It loves the Piggle, its mother, so much, and its eaten So much that it's sick. Piggle: The Piggle's baby has eaten too much Me: The new thing you want is about the Winnicott baby and The Piggle mother, about Winnicott loving the Piggle [mother], eating the Piggle, and being sick. (Winnicott, page 25) Here one might suggest that Winnicott and the Piggle are drawing a close association between the Piggle's mother, and her pregnancy: eating a baby, having too much (being fat/pregnant), and then being sick - perhaps giving birth to the previously 'eaten' baby. We can see from this that the Piggle may already have seen the Black mummy prior to the sister's birth, during the mother's pregnancy. It is also interesting to note that the Piggle did not much like Winnicott being her baby, and did not want to play the game again. Winnicott shortly after describes the black mummy as being hate, directed at her parents "The subject of daddy giving mummy a baby" (Winnicott, page 48). This seems to be the origins of the Piggle's problems with the nightmare figures. It may not be coincidence that, after this session where the hate is revealed to Dr Winnicott, the Piggle becomes obsessed with dead things: "Talk about dead things has lately become prominent" (Winnicott, page 52), and this is tied up with the black mummy, and her breasts. Gradually, we see the Piggle growing into the oedipal complex, which is the beginning of resolution. The next session sees Winnicott assess the Piggle as having "Idea evolving of mummy being angry with Gabrielle for being daddy's little girl". (Winnicott, page 63). Clearly this is an essential fantasy, because this is the beginning of the mother/daughter rivalry of the female Oedipal complex (Sometimes called the Electra complex), where the daughter wishes to marry the father, in order to have his penis - the essential step for development which will become the desire to have a baby (Penis replacement). She makes her mother apprehensive by talking about this "She has also talked about wanting me dead and sleeping with her father" (Winnicott, page 107). The next interesting step begins after the seventh session, when Gabrielle describes to her mother "I have paid the black mummy" (Winnicott, page 106). The mother is fearful that Gabrielle is saying that she has used an aspect of herself as payment in order to keep the mummy quiet. However, one can also see at as having 'paid attention' to the black mummy, i.e. having had the hate and love parts become as one: the black mummy is subsumed within the aspects of the real mother. She still refers to the black mummy, but now she is a lot less abstract, and a creature of nightmare. Now she is seeing positive aspects in the black mummy, which indicates that the payment is a reconciliation between the good and bad mothers of Piggle's psyche. This resolution comes with the beginning of the Oedipal complex; as though this latter thing were a relief of the pressure which had been building up in Gabrielle's unconscious. Winnicott and Piggle The question of whether Winnicott was actually good for Piggle must be answered with a mind to both the Piggle's own benefits, and those benefits as they were perceived by the parents. As it can be considered that the parents had a big role to play, firstly in pushing Piggle into treatment, and then in the direction which this treatment took, their needs have to be considered. Firstly, it should be pointed out that the parents were in communication throughout the treatment, and that they had considerably more access to Winnicott than the Piggle did herself; in the first few sessions one gets the impression that they rang him, and wrote to him, whenever Piggle exhibited behaviour which they did not approve of. Secondly, the Piggle's problems seem in some way to be a reflection of the parent's own expressed confusion between the 'old' Piggle, who was graceful and quiet, and the 'new' Piggle, who demands their attention at every turn. We can see this in the way in which her Mother describes her as falling and needing attention more often; this is mirrored by the black mummy, who also falls often. As it is not unlikely that the bad mummy also represents aspects of the Piggle, the parent's fears about the new Piggle may be being played out through the Black Mummy and the Babacar. The parent's expectations are also mimicked in the way in which Piggle sees Dr Winnicott. She desires to see him quite often, and this is usually described by the parents in the context of something which the Piggle has done which they disapprove of (usually hitting her sister). This disapproval, which prompted the parents to have Gabrielle treated in the first place, no doubt affects their relationship with their daughter. Therefore, their relief that Piggle seems to be getting better may be a cause of that benefit, rather than a symptom of such benefits. The Piggle has clearly been benefited by her visits to Dr Winnicott; there are fewer nightmares after her first few sessions, and the parents are pleased with her, thereby contributing to a more satisfactory relationship between themselves and their daughter. One may also speculate that the Piggle's behaviour is in part caused by attention-seeking; her special visits to Winnicott no doubt gave her exactly this attention: demands to see the doctor may be focussed upon such seeking. The three years which it took for Piggle to be completely benefited are three years in which child-development occurs rapidly; whether the Piggle would simply have grown out of her problems, moving towards the oedipal complex at her own pace, cannot be known. What does seem clear is that the Piggle was benefited by the onset of this complex: some early resolution was gained very quickly after the onset of these symptoms. However, despite these reservations, it also seems clear that the benefit of offering Piggle insights into her behaviour allowed her to begin the Oedipal complex; without Winnicott's assistance, Gabrielle may have taken a great deal longer to achieve this, and in this sense Winnicott was good for the Piggle. Bibliography Winnicott, D M. (1991) The Piggle: An Account of the Psychoanalytic Treatment of a Little Girl Penguin Read More