Exploring Feeding Difficulties in Children

The Generosity of Acceptance

Jane Desmarais, Kent Ravenscroft, Gianna Polacco Williams, Paul ((Psychotherapist)) Williams, Jane Desmarais, Kent Ravenscroft, Gianna Polacco Williams, Paul ((Psychotherapist)) Williams

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429913440
• Edition: 1
• Topic: Psychologie
• Subtopic: Histoire et théorie en psychologie

The number of people suffering from different eating disorders has grown dramatically within the last twenty years. These two volumes examine feeding difficulties and eating disorders in children and adolescents, from babies to 19-year-olds. The volumes consist of clinical cases that describe the process of psychoanalytic psychotherapy used to treat the patients. The contributors look at the underlying causes for the disorders, such as bulimia and anorexia, lead to a normal life with the help of psychoanalytic psychotherapy. In addition, this collection takes into account the profound effects eating disorders have, not only on the patients, but on their immediate family and friends as well.'Many cases describe the anxieties and strategies of defence used against feelings of dependence and the risk of accepting from another. This is a core theme in both volumes and is the principal idea behind the paradoxical title, The Generosity of Acceptance.

Chapter One
Idealization and contempt: dual aspects of the process of devaluation of the breast in a feeding relationship

Lynda Miller

It is ironic and perhaps also rather sad that a retrospective reading-through of my mother and infant observations, which comprised an essential part of my pre-clinical training, led me to formulate the title of this chapter. The irony and sadness lie, I think, in the contrast, described in this chapter, between the mother's highly idealized conscious ideas about breast-feeding, and the less conscious and unconscious processes by which the breast seemed to become a devalued and at times contemptible object for her baby.

I observed this mother, Jenny, with her baby, Anna, on a weekly basis over a period of two years, and subsequently on infrequent occasions. At the time of Anna's birth, Jenny and her boyfriend Michael, both of whom are Australian, were living in a "commune" in a large semi-derelict house with a group of friends. Inside, the room shared by the couple was brightly painted and well cared for, and the parents-to-be were adamant that their first child would be born in their home with as little medical intervention as possible.

At my first meeting with Jenny and Michael, they emphasized to me their particular views on child-rearing, and they both seemed to adhere quite rigidly to an "alternative" ideology by which certain ideas and practices were deemed good as opposed to others that were seen as extremely bad. To give some of the most relevant examples: Jenny felt that a hospital birth would inevitably produce a traumatized and damaged baby, and she warned me that observations might be impeded by the fact that she intended to carry the baby next to her body all the time. She also made frequent references to the diet that she followed, consisting of a very limited range of health foods that she felt were "pure" as opposed to the "contaminated" food—in particular, any animal product—eaten by most people in our culture.

In accord with the parents' wishes, Anna was born at home among a circle of close friends. Jenny gave birth in a supported squatting position, and after seven hours of labour Anna was delivered into a bath of warm water and, in Jenny's words, "lay there smiling, looking all around". Jenny reported triumphantly that no drugs at all had been needed, and that the fight she had anticipated having with her doctor if he tried to make her take a drug to expel the placenta had not even been necessary, as it had come away naturally.

A most significant aspect of this anti-orthodox ideology was the belief apparently held by Jenny that the breast would provide for all Anna's needs and would serve to maintain a blissful state of fusion between mother and baby, almost as if the separative act of birth could be nullified. Accordingly, the breast was always available to Anna throughout day and night, and she was not yet fully weaned at 3½ years of age. The popular term "demand feeding" is not truly applicable here, as Jenny would offer Arnia the breast whenever she showed any sign of distress, even when a feed did not seem at all to be what the baby had in mind.

I have selected observations that I hope will illustrate the qualities that for me characterize the feeding relationship of this nursing couple, with particular reference to the fate of the mother's aspiration to achieve and sustain an idealized symbiotic fusion with her baby. I shall begin with some excerpts from the very earliest observations following the birth.

Anna was just 13 days old and Jenny had been feeding her almost every hour, just offering one breast at each feed time in order, in Jenny's words, "not to break the natural flow and rhythm of the sucking".

The baby looked very relaxed held in Jenny's arms ... her face became increasingly red and bloated, eyes more closed yet never rally as the feed progressed. She seemed to stare upwards or towards the breast, not at Jenny's face. Jenny did not speak at all. ... She focused intently on the baby all the time. At one point the baby made an "Aaa" soft sighing sound, and Jenny echoed this.

Later in the same observation, following her feed at one breast, Anna was lying across Jenny's lap gazing up at her:

The baby made little sounds, and Jenny gently moved her around, sometimes echoing her, saying "Aaa" very softly. The baby gave a sudden loud cry followed by panting, and Jenny said "Oh, you want some more?" lifting her sweater and offering the other breast which the baby took eagerly, sucking intently, very still and quiet. After a few minutes the baby no longer appeared to be sucking, yet lay still with the nipple in her mouth.

Although here Jenny had a fixed preconception in her mind about offering only one breast, she was sufficiently receptive and flexible to be able to learn from her baby's communications and to respond by offering both breasts consecutively from then on. In these first few weeks of Anna's life, despite exhaustion, Jenny seemed to be totally absorbed in her baby and to feel sustained by an experience of "at oneness", unfractured by any sense of separateness.

By the time Anna was 23 days old there were already indications, observed in the following extract, that the harmonious quality of this feeding relationship was under threat:

Anna began to cry a little, making small "Aaa" sounds, some quite deep and full. Jenny described to me how her mother had visited last week, which had "got under her skin" and made her irritable, and she was sure the baby had picked up her mood. Anna cried more loudly, vigorously kicking her legs and clenching her fists. Jenny said to her, "I've been a grumpy mummy haven't I? What is it you want? Is it a feed?" She unbuttoned her dress, and Anna immediately turned her head to the nipple and sucked vigorously, panting at first and making little sounds with each suck. Anna suddenly let go of the nipple and turned her head away from the breast, and Jenny lifted her and turned her around, offering the other breast. At first Anna sharply turned her head away, then took the nipple when Jenny held it between two of her fingers. Anna continued to suck vigorously, sometimes making a loud kissing sound with her lips. Her cheeks became increasingly red and bloated and her eyes glazed and shining. After a few more minutes sucking, Anna began to turn her head rapidly from side to side, a small but quick repeated movement. I could not see but I think her mouth was alternately making and losing contact with the nipple. Jenny said "Is this a game, eh?" but whenever she tried to move Anna away from the breast, Anna gave a loud cry. She became more distressed, kicking her legs hard, beating her arms up and down, intermittently turning her head to and fro. Jenny said "Have you had enough?" but Anna cried louder still. She did not seem to want the breast, yet she could not relinquish it, repeatedly turning towards it, then away. Jenny said to me, "This is the worst bit, when I just don't know what she wants. She seems to live in her own world and screams when she has finished feeding."

It seemed that misunderstandings were beginning to arise between mother and baby, In a number of my observations of the first few months, a pattern emerged in which Anna would turn repeatedly towards and away from the breast when it was offered and she did not necessarily want to suckle. Anna's experience of the breast clearly did not always match Jenny's idealization, and she seemed through her ambivalence to be challenging her mother's belief that the breast could ameliorate any painful feelings.

In her paper "Envy and Gratitude", Melanie Klein (1957) stressed the importance of differentiating between a good object and an idealized object. Although this distinction cannot be absolute, she states: "A very deep split between the two aspects of the object indicates that it is not the good and the bad object that are being kept apart but an idealized and an extremely bad one. So deep and sharp a division reveals that destructive impulses, envy and persecutory anxiety are very strong and that idealization serves mainly as a defence against these emotions" (p. 192). When the split is not excessive, the processes of ego integration and object synthesis so necessary for healthy development can come into operation, allowing identification with a good object to become established.

From the flavour of the observation described above, strong persecutory elements seemed to be present, evidenced especially in Anna's screaming following a feed. In Klein's view (1957): "Excessive idealisation denotes that persecution is the main driving force ... idealisation is a corollary of persecutory anxiety—a defence against it—and the ideal breast is the counterpart of the devouring breast" (p. 193).

Furthermore, the distressed, repetitive maimer in which Anna turned to and from the breast suggested a confused state of mind, not typical of the developmental sort of splitting that leads to a capacity to discriminate between goodness and badness. This baby's confusion could perhaps be understood in terms of a projective identification with her mother's state of mind. Jenny's tendency towards excessive splitting can clearly be seen in her attitudes towards many aspects of her life—food in particular, as described earlier. Mrs Klein (1957) speaks of an incapacity to possess a good object, which is dealt with by means of idealization, and which "is also bound up with the confusion between good and bad that arises in the relation to the primal object" (p. 193). She adds in a footnote that the mother-baby relation is particularly idealized by "... those people who were not able to experience sufficient happiness in this relation" (p. 193). I think this may have been the case for this mother, and I will elaborate upon this later. With regard to the baby, it seemed that she was in collusion with her mother's idealization of the breast, thereby also being prone to experiencing the intensely persecutory aspect of her object, especially, as I gathered from Jenny, during the night.

Since her birth Anna had always slept in the same bed as her parents. She awoke frequently throughout the night, and Jenny would always give her the breast to pacify her. Usually she would quieten and fall asleep again, but on some occasions Jenny told me that Anna would refuse the breast and scream relentlessly.

When Anna was 6 weeks old, Jenny related an incident that had taken place the previous night and which highlighted for me the parents' belief in a sensual, physical mode of containment. Jenny described how on one particularly bad night when Anna had been screaming for half an hour, she and Michael managed eventually to soothe her by taking off all their clothes and giving Anna "a really close cuddle", sandwiching her between their naked bodies.

When Anna was a few months old a small room became vacant in the house, and this was allocated to the new family. Mother and baby continued to share a bed in the larger room while father moved into the new room to sleep. The physical closeness between Jenny and Anna was sustained throughout most of the day, because Jenny carried Anna in a front sling as a small baby and, when she grew heavier, in a back-pack. Thus eye-to-eye contact between mother and baby was minimal.

During the early months of her life, the expression I saw most often on Anna's face was a rather dreamy, hazy one; she would gaze into space and did not often seek or respond to direct eye contact. This is from an observation when Anna was 1½ months old:

I sat Anna on my lap and she turned her head towards me and looked up but not directly at me. She held onto my fingers loosely, moving her fingertips rhythmically. Her eyes moved a little from side to side, focused in my direction but seeming to avoid my eyes and face.

Where the emphasis is placed so heavily upon physical holding, as with this mother and baby, rather than upon an experience of being held in mind, of being looked at and talked to by a mother who wants to get to know her baby, it is possible that development might be hindered in some respects. A superficial "adhesive" kind of identification precludes the dimension of depth prerequisite for discovery and the growth of knowledge. In "adhesive identification", the infant feels itself to be held together only when it is attached to its object, and I think that this term is applicable to some extent to this mother and baby.

Esther Bick, in her well-known paper on infant observation (1964),¹ gives examples of two different ways in which mothers and babies relate to each other: first, a mode that is predominantly visual and vocal; second, one in which tactile and kinaesthetic communication is preferred. Although either mode can provide a satisfactory basis for containment and growth, clearly both are essential in varying degrees for a baby's potential to unfold, and one should not totally preclude the other.

For Jenny and Anna, as the latter's experience of containment relied so strongly upon the uninterrupted sensation of mouth-to-nipple and skin-to-skin contact, it became almost impossible for Jenny to put her down without Anna becoming very distressed. In this observation (Anna, 1½ months), following a feed, Jenny was carrying Anna in her arms, walking around the room and patting her back:

Anna's head flopped right over to one side on Jenny's shoulder, and her eyelids kept drooping and closing. She then seemed to be trying to keep them open. This happened a few times then she fell asleep. Jenny said "amazing—I'll give her five minutes" and very gently lowered her down, head first into a basket on the floor. While being lowered Anna suddenly moved her arms out and spread her fingers as if experiencing a sensation of falling.

Perhaps Anna lost her sense of being held together in one piece when the contact of her body with her mother's body was broken.

The next week, when Anna had again just fallen asleep in Jenny's arms and was being lowered into her basket,

Anna's eyes remained closed but her breathing became louder and she rapidly opened and closed her fists. As her head touched the bottom of the basket her eyes flickered open. Jenny placed her hand on Anna's head and bent right over her. Anna looked up at Jenny and made little whimpering sounds. After a few minutes, Jenny tried to withdraw her hand and began to speak to me, but immediately Anna's eyes opened wide. She screwed up her face and cried loudly.

Anna would not be pacified, and when Jenny offered the breast, guiding Anna's mouth to the nipple, she refused it with a cry of protest:

Anna's left hand was near to the nipple, and she appeared to be grabbing and pinching the breast as she pushed it away and arched back.

Edna O'Shaughnessy (1964) utilizes Bion's ideas in describing a feature of an infant's relationship to the breast in its presence and in its absence. She suggests that "When the infant feels hungry and in need of the breast, he is aware of a need not satisfied. This frustration, the pain of his hunger, is what is present to him, and this, initially, is felt as a bad breast present" (p. 35).

Perhaps for Anna, the proximity of her mother's body, with a focus on the breast, had become almost indispensable because she had very rarely been allowed to experience any frustration and thus to begin to deal with an absent object. On the occasions when Jenny does try to put Anna down to sleep by herself, it could be that a phantasy of a bad breast is projected into the actual breast when it reappears, because no time is allowed for Anna to process this experience at a mental level. Anna is in fact being deprived of the experience of an absent object because Jenny so readily offers the breast at the first sign of frustration. In O'Shaughnessy's view, this would not be conducive to the development of thinking.

In the months that followed there did seem to be a lessening of the undifferentiated, collusive elements in the relationship, at least in part initiated by Anna as in the following excerpt (Anna, 2 months, 1 week):

Anna made little sounds which gradually became closer to cries, arching her head back and waving her outside arm. Jenny lifted her sweater saying "You know what's coming don't you?" and offered the breast. Anna did not turn her head towards the nipple, so Jenny gently guided her there. Anna took the nipple in her mouth but did not seem to suck, her hands fingering Jenny's sweater.

Jenny interpreted to Anna that she just wanted the experience, not any milk, adding softly "You don't care at all do you? You don't care." And a few minutes later:

Jenny pulled up her sweater and offered the breast saying "here it is" then "you don't prefer your fingers do you?" when Anna seemed to be trying to cram her fist into her mouth and did not take the breast.

At 7½ months, Anna was able to pull herself to a standing position and took a triumphant delight in this independent achievement. Jenny congratulated her with great pleasure, and there seemed to be a lessening in the adhesive quality of their contact and more signs of Anna achieving a degree of ego integration.

At the same time, on "bad" days I saw quite a different side of Anna. One observation took place entirely on Jenny's bed on a day when she seemed especially tired and dejected:

Anna continued to play with the brush, vocalizing quietly and frequently looking up at me. Jenny curled up on her side behind Anna and appeared to fall asleep instantly. Without turning around, Anna suddenly dropped the brash and reached out behind herself with her arm extended until she touched Jenny, toppling over as she did so ... she grabbed at Jenny's nose and pulled it, then at her lips, trying to grip them firmly. Later, Anna grabbed at her lips and nose again, and Jenny sighed and said "Is it time for titty again?" Anna grabbed at Jenny's blouse, and as soon as Jenny had undone the buttons she grasped the nipple and pulled it into her mouth, sucking hard and noisily. With her outside arm she reached for the other breast, and when Jenny pulled open her blouse fully, Anna grasped the other nipple, fingering and pulling at it while sucking the first breast.

On days like this Anna seemed to lose any sense of boundary between herself and her mother in a manner suggestive of projective identification, whereby in phantasy split-off parts of the self, or even the whole self, are projected into the mother...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• ACKNOWLEDGEMENTS
• EDITORS AND CONTRIBUTORS
• INTRODUCTION
• CHAPTER ONE Idealization and contempt: dual aspects of the process of devaluation of the breast in a feeding relationship
• CHAPTER TWO Feeding difficulties in infancy: Faruk and Shereen
• CHAPTER THREE Getting to know Miral: some thoughts on the nature of feeding difficulties in the psychotherapy of a 5-year-old boy
• CHAPTER FOUR A latency boy's eating difficulties and their meaning in his inner world
• CHAPTER FIVE Aspects of the body image and sense of identity in a boy with autism: implications for eating disorders
• CHAPTER SIX Marco: a story of a school relationship
• REFERENCES