Click here to Read:  Lourdes Lynch’s Powerpoint on Child Development from Wuhan, China.

Click Here to Read:  Arthur Lynch’s Klein and Winnicott Wuhan Powerpoint.

 Click Here to Read: A rthur Lynch’s Freud powerpoint from Wuhan, China. 

Introduction by Arthur Lynch      

    Visiting and teaching in Wuhan was an exceptional experience.  To give some back groundWuhan, the capital of theHubeiprovince, is one of the largest cities inChinaand was ranked by National Geographic as the tenth largest city in the world.  With its 3,500-year-long history, Wuhan is one of the China’s oldest and civilized cities, older than Beijing, Xi’an and Nanjing. It is known as a central hub for political, economic, financial, cultural, and educational activity and has retained the name of “Water City” because it lies between the Yangtze and Han rivers resulting in beautiful natural landscape. In China, Wuhan ranks fourth in population and third in academic science and technology.

          Teaching in Wuhan was an exciting project.  The students’ days were structured in three segments with an optional experience.  In the morning they would hear a lecture, the bulk of which are being put on the blog.  After a brief lunch they would break into supervision groups of 20 or more students and present cases in a format previously determined.  The supervision went from 2:00 to 5:15 and could accommodate two or three cases.  As anyone familiar with groups might imagine, they started out slowly with people turning more to the group leader but this quickly transformed into an excited involvement. In the evening, the participants would return for another lecture.  During the supervision time some students would step out for a “personal life experience” meeting with an analyst for a session. 

            Lourdes and I presented material on object relations theory and child development – borrowing from the work on toxic stress by the “Center on the Developing Child” at Harvard University. Lourdes Lynch’s power point is above, Arthur Lynch’s powerpoint to follow in a later post.

Click Here to Read: Pictures: 3,000 Ancient Buddhas Unearthed in China by Ker Than on the National Geographic website on April 17. 2012.

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NOTES FROM WUHAN: PSYCHOANALYSIS AND SHAKESPEARE
JEFFREY STERN, PH.D.

Here is the talk I gave in Wuhan on Friday, April 13th. I was going to read the entire article I’d published years ago in Shakespeare Quarterly, but could see that it would be tedious to do so given that I’d have to stop every sentence for the translator and given that the text had already been translated for the attendees into Chinese. At the same time I didn’t think it safe simply to spend my allotted time responding to questions on the expectation that the audience would have indeed read the paper and read the play. So what I did was read a shortened and revised version of the paper after showing clips of the relevant scenes from the Trevor Nunn Royal Shakespeare Company film of the play with Mandarin subtitles. This seemed to work very well. The film clips connected the audience to Lear in a direct and visceral way and revising my paper allowed me to rethink it in the terms of the conference, that is, to incorporate Arnold Richards’ ideas about “Replacement Children” into my text as well as Professor Xudong Zhao’s thoughts about China’s “One Child Only Policy.” These ideas I thought spoke powerfully to King Lear, especially a King Lear under consideration in contemporary China.

When I finished my prepared text I asked for questions and was greeted with a loud silence. So I talked about the commonalities between the beginnings
of Shakespeare’s plays and the beginnings of our clinical cases. And then my translator asked me what I would say to Cordelia if she walked into my office angrily complaining of the way her father had ruined her wedding day. Suddenly we were off to the races. Everyone now had a question! Would I say that King Lear was a narcissist? Why, from a psychoanalytic perspective do I think that women always fall for “bad boys” like Gloucester’s evil son Edmund the Bastard? What is the relevance of theater to psychotherapeutic practice? Could it be argued that Chinese mothers in particular often use their sons as selfobjects even as Lear uses Cordelia? And so on and so on. The time flew and all too quickly it was over.

Pas de deux in Wuhan, China
N. Szajnberg, MD, Managing Editor

Invited to teach in China about psychoanalytic development, how does a psychoanalyst select something that is more cross cultural than not?  I chose to teach attachment theory, born of the mind of a psychoanalyst, John Bowlby, exiled for some decades and now returned to psychoanalytic interest since the work of Fonagy, the Steeles, Lieberman and others. 

Here is a brief snippet of the three hour lecture with video from Everett Waters’ website. I thank the Wallerstein Foundation for its ongoing support, Arnie and Arlene Richards and Dr. Tong for this invitation.

If there is enough reader interest, we can develop this as a primer that covers adult attachment and implications for psychoanalytic technique. This would be available through IPBooks.

Nathan Szajnberg, MD, Managing Editor

Attachment: a Pas de Deux of Exploration, Security and Comfort
Wuhang China April 2012

Copyright 2012 N. Szajnberg, MD

Today, we think about attachment of children and parents. This is crosscultural, universal.  Attachment — an unfortunately abstract,  motionally-distant word — describes how, in moments of fear or anxiety, one seeks proximity and comfort, security.  And, if secure, one can explore new worlds.  John Bowlby used ethology to understand the major motivating drives in humans. Protection is fundamentally human: it fits Freud’s self-preservative instinct: something inborn, natural and necessary for survival.1 Bowlby’s early work with adolescent delinquents struck him: many of these teen hoodlums gave histories of early childhood loss and separations. When asked by the World Health Organization to design guidelines for better emotional health, that is suggestions that would be effective across cultures for the human species, Bowlby developed his ideas that he called attachment.  He wrote three volumes: Attachment, Separation and Loss.

Juvenile primates have a long and vulnerable dependency. In evolution, the juvenile must survive in a savage environment. We need inborn, internal mechanisms to seek safety quickly, mechanisms that do not need to be taught, but can be “released” by a strong emotion, fear of an external threat, or anxiety associated with separation or strangers. Further, an adult must respond by providing security. (If not, we are eaten.) In animal ethology, for instance, baby seagulls are born with an inborn mechanism of beak opening when they see the red dot beneath the mother seagull bill bobbing; goslings are born with a mechanism to follow the first large figure. Rene Spitz demonstrated that infants show a social smile responding to an adult’s smiling face bobbing vertically2 (a still face elicits distress or gaze aversion).

This review is perfunctory of what we have learned over six decades. Bowlby established the basic concepts and observations for the human infant’s or toddler’s ways of finding security and comfort when faced with fear or anxiety. Observing children in the hospital with long separations from their parents, The children went through three stages: first, anger and protest, then wheepy despair, then detachment in the presence of the mother. When the detached children were with other caregivers, such as nurses or doctors, they were often friendly; only when mother entered, did the child gaze avert and distant itself. Upon reunion with the parent after a prolonged separation, these children would reverse the sequence from detachment, to despair to protesting anger, to reattachment. Unaware parents upon reunion are confused about the child’s wheepy or irritated and angry.

Later, Bowlby recognized that attachment represented a balance between exploration and security and on close contact, comfort. Toddling primates newly found mobility means being able to explore the environment — climb a sapling, for instance. But, danger exists the further one wanders from a protective adult: an inborn mechanism to return to the adult for safety and comfort must exist for the juvenile primate to survive dangers such as predators. No time to think about this; it must be reflexive.  He also connected mourning with attachment.

His student Mary Ainsworth confirmed that attachment is crosscultural. She showed first, that the mother’s caregiving in the first year strongly influences the pattern of the toddler’s attachment; second, toddlers have three patterns of attachment: one secure pattern (“B”) and two insecure — avoidant (“A”) and resistant (“C”). (A fourth D, Disorganized was described later and will be discussed in the latter part of this presentation.)

In decades of studying several thousand infants from many cultures, we know that about 60% are securely attached and 40% insecurely attached.

Culture matters, however in insecure attachment type. In Japan, an insecurely attached child, is likely Type C, resistant ambivalent. In Northern Germany, an insecurely attached child is likely to be avoidant.  This fits with the mothering styles seen in the home: German mothers value and foster early independence; Japanese mothers value or favor dependence, or amae .

Maternal Sensitivity is critical: it is clearly

Ainsworth studied and demonstrated the “key features of parental care that help organize early secure base behavior.” (Waters, website).

She focused on four aspects of early care:

1. Sensitivity to infant signals;

2. Cooperation as opposed to interference;

3. Availability

4. Acceptance (versus rejection) of needs. cf. Waters website)

 Maternal sensitivity is judged based on some twelve hours of observations. The ratings are from Highly Sensitive (9), to Sensitive (7), to Inconsistently Sensitive (5), to Insensitive (3), to Highly Insensitive (1).

I offer some theory and background here for how Bowlby influenced these ideas. Bowlby referred to the infant and child’s “ordinary expectable environment,” influenced by ethological research that suggested that evolution provides basic genomic readiness to respond to environmental cues in order to develop more complex development consistent with survival. Compare this to Winnicott’s The Maturational Drive and the Facilitating Environment,” which captures both features of genomic built-in information and the environmental facilitation that permits maturation to evolve into development.

Sensitivity, has four essential components:

1. Awareness of infant signals (e.g. Five types of inborn cries)

2. Interpretation

3. Appropriate response

4. Prompt response.

Accurate interpretation has three main components (a)

awareness,…, (b) freedom from distortion, and (c) empathy. An inattentive, “ignoring” mother is unable to interpret correctly the baby’s signals when they break …she has been unaware of the prodromal signs. A mother …may misinterpret signals because her perception is distorted by projection, denial, or other marked defensive operations.   Mothers who have distorted perceptions tend to bias their “reading” of their babies according to their own wishes, moods, and fantasies. For example, a mother not wishing to attend to her baby might interpret his fussy bids for attention as fatigue and, therefore, put him to bed’ she in a hurry, might perceive any slowing down in the rate of feeding as a sign of satiation. Similarly, a mother who is somewhat rejecting of her infant might perceive him as rejecting and aggressive towards herself. Mothers who least distort their perceptions of their babies have some insight as to their own wishes and moods, and thus can more realistically judge the baby’s behavior. Furthermore, they are usually aware of how their own behavior and moods affect their infant’s behavior. The mother must be able to empathize with her baby’s feelings and wishes before she can respond with sensitivity. That is, a mother might be quite aware of and understand accurately the baby’s behavior and the circumstances leading to her baby’s distress or demands, but because she is unable to empathize with him–unable to see things from the baby’s point of view–she may tease him back in to good humor, mock him, laugh at him, or just ignore him.

The mother’s egocentricity and lack of empathy may also lead to detached, intellectual responses to the baby rather than to warm, sensitive interactions with the baby. (cf. Flarsheim  in Giovacchini, Tactics and Techniques Vol II, 1975, P. 155, 1-95; “The Therapist’s collusion with the Patient’s Wish for Suicide”)]

……………..

“The Poker “Tell” for attachment behavior at one year”

In Poker, card players look for a “tell,” a non-verbal hint about the opponent’s “hand.” His pupils dilate when he has a good hand, or he shows an idiosyncratic gesture, such as touching one’s ear. James Bond uses this in Casino Royale.  What is the ‘tell” for attachment behavior which reveals the infant’s underlying thoughts and feelings about seeking a secure base?  Watch the Reunion episode. of the twenty-two minute laboratory strange situation that induces separation anxiety and offers reunion.

Click Here to View Video

Upon reunion: does s/he approach the parent? If so, does s/he reach up? If so, does s/he tuck up his knees into the parent’s torso (or is he like a sack of potatoes)? Does s/he place the hands palm down on the parent’s shoulders? Does s/he nestle its head into the neck? Does s/he seem comforted? This gives some sense of the eloquent ballet performed by toddlers when distressed.

From the Strange Situation, one can classify toddlers’ attachment into Secure or Insecure anxious (avoidant or resistant/ambivalent) attachment.

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SLIDE 25 : ABC DISTRIBUTION

,……….

[Some years later, a fourth category was described, “D” for disorganized. It is different than the previous three categories: in A, B and C, the child has some mental strategy for turning to a parent for succor; the D child seems disorganized, doesn’t have an idea of what to expect from that parent.]

Attachment is constructed between a child and each caregiver. The same child may be securely attached to one parent and insecure to another, or a grandparent. We showed no evidence for genetic loading of attachment.

And attachment classification is stable after twelve months, unless there is a profound shift in the child’s life: trauma or extraordinary amelioration. That is, an insecure twelve-month child of a homeless mother, if given a home by eighteen months, may shift to secure attachment (Waters).

(End Part One Introduction).

Part Two continues with adult attachment and implications for psychoanalytic technique with children and adults.

1 In addition to the self-protective and sexual “instincts,” — that is in addition to what Freeman Dyson refers to as all cell life’s processes for reproduction and life maintenance — there is also the biological drive towards diminution and death. Pyknosis, apopotosis, and karyorrhexis, are cell mechanisms of aging and selfdestruction, suggest a third characteristic of living beings: aging and death. Pyknosis is “the irreversible condensation of chromatin in the nucleus of a cell undergoing necrosis [1] or apoptosis.[2] It is followed by karyorrhexis, or fragmentation of the nucleus.”   Wikipedia.  We will not cover that here.

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Click Here to Read: International Journal of Applied Psychoanalyit Studies September 2011 Issue focusing on China on the Wiley Online LIbrary website.