March 21

a person may just be born with  a more active amygdala, even though it is genetic and runs in families

FREUD says it is “anger turned inward

Someone else says the person can not elf sooth or mirror


Normal grief

pathological grief

inhibited grief: ansence or distortion of what is normally expected

chronic grief: when it does not diminish

—-Pst pardum stuff, dads who get post pardum

The real cradle that holds the baby is the marriage bond of the parents


parent’s first reaction won’t be the last

Why do Latinos have a higher suicide ate?

girls are expected to navigate and negotiate Western systems on behalf of their families and that takes time away from their own roles and lives

Image result for gender bias personality disorder

Gender Differences Psychiatric Illness

attunement – reminds me of Melissa who loved her but had no bonding with them as little kids

The First Subphase: Differentiation and the Development of the Body Image (6-10 Months)

At the age of 4 to 5 months, the peak of symbiosis, differentiation is observed. By this time the achievement of the social smile indicates the establishment of the specific bond. A central core of dim body awareness is hypothesized, based on behaviors that demarcate self from other. For example, the infant is observed molding to his mother, distancing from her, feeling his own and is mother’s bodies, and handling transitional objects.

Six to seven months is importantly marked by hatching, defined by Mahler has a gradual ontogenetic evolution of the sensorium, characterized by a new look of alertness, persistence, and goal directedness. The child is observed pulling at his mother’s hair and ears, feeding her, straining back for a better look at her, all in contrast to the earlier molding into mother when held.

The child’s creation at this time of transitional objects is a monument to his need for contact with the mother’s body. In addition, the mother’s preferred soothing or stimulating pattern is taken over, assimilated as a transitional pattern.

At seven to eight months, the infant develops a checking-back-to-mother pattern. Mahler calls this the most important normal pattern of cognitive and emotional development. The baby begins with comparative scanning, comparing mother with the other. He becomes more and more familiar with how she feels, tastes, smells, and looks.

Mahler writes that the well-documented stranger reaction and stranger anxiety developing at this period can also incorporate curiosity and eagerness to find out about the stranger, once the stranger has averted his or gaze. When the infant is sufficiently individuated to recognize the mother’s face and is quite familiar with her moods, he turns with more or less wonderment and apprehension to a prolonged visual and tactile exploration of the faces of others, always checking back to mother’s face. With an optimal symbiotic phase and with optimal confident expectation, curiosity and wonderment predominate; in children whose basic trust is less than optimal, an abrupt change to the acute stranger anxiety made familiar by Spitz (1965) may occur, or, alternatively, prolonged mild stranger reactions, which interfere with inspective behavior, may take place. The infant’s response to the stranger becomes evaluative both of his socialization process and his first steps toward emotional object constancy.

When symbiosis is delayed or premature, differentiation is similarly delayed or premature. Such disturbed symbiosis can be caused by the mother’s indifference, ambivalence, intrusiveness, or unpredictability.

Mahler notes that as important as inborn potential is for eventual harmonious personality development, a favorable mother-child interaction also affects subphase adequacy. The mother, too, has to adapt, particularly at crucial periods.

Mahler and her colleagues (1975) conclude

It is the specific unconscious need of the mother that activates out of the child’s infinite potentialities those in particular that create for each mother “the child” who reflects her own unique and individual needs. This process takes place of course within the range of the child’s innate endowment [p. 60].

The Second Subphase: Practicing (10-17 Months)

As the child enters the practicing subphase, he and his mother are less able to take undisturbed pleasure in their close physical contact with one another, but they can enjoy one another at a greater distance. The mother who has difficulty relating to her child tends to want him to grow up quickly as soon as he seeks to distance himself. Such children, in turn, find it difficult to give up a demanding closeness. On the other hand, children who have had the best relationships with their mothers can now venture the farthest from her; but when they become concerned about separation, they are able to turn to her once again. How the child perceives the widening world depends on mother, for while the thrust for individuation is an innate given, it can be experienced as painful if mother is not available to alleviate fears, falls, and hurts.

The central feature of the practicing subphase is the late investment in the exercise of autonomous functions, especially motility, to near exclusion of interest in the mother. Optimal distance allows for free exploration at the same time that it permits refueling, a “perking up” for further exploration. Mahler concludes that during this early practicing subphase, all children have some separation anxiety and require the use of the distance modalities of hearing and seeing mother in order to enable them to move physically from her.

The practicing subphase proper, from 10 or 12 to 16 or 18 months, is characterized by Greenacre’s (1957) concept of a “love affair with the world”. Children attain a new visual level in upright locomotion, which offers them continuously new and interesting sites. This period constitutes the height of narcissism, when the child invests his own functions and his own body, as well as objects and objectives of his expanding reality. Impervious to falls and other frustrations, he is more easily able to substitute other adults for his mother to get reassurance.

Mahler emphasizes the importance to emotional development of the capacity to walk, which allows the child to test reality and his own control and mastery of the world. Individuation and identity formation are augmented. The mother both renounces and continues to possess the child’s body. Delay in the child’s locomotion results in concomitant delay in the experience of a love affair with the world. Walking thus has great symbolic meaning for both mother and child, indicating to the mother that the child will make it and adding to the child’s developing self-esteem.

The child’s mood can be described as low-key in mother’s absence. Gestures and performance are slowed down, interest in surroundings diminished, and the child appears preoccupied with inwardly concentrated attention, with “imaging.” When a person other than the mother actively attempts to comfort the child, his emotional balance is lost, and tears result. The low-keyed state ends with mother’s return. This state, and the inferred attempt to image the mother, is seen by Mahler as a miniature anaclitic depression and an attempt to hold on to the ideal state of the self.

A disturbed practicing subphase may include greater than average separation anxiety, more than average shadowing of the mother or impulsive darting away from her, and excessive sleep disturbance.

The Third Subphase: Rapprochement (17-24 Months)

In the early rapprochement subphase, mother is no longer just home base, but also a person with whom the child wishes to share his discoveries, wanting her interest and participation. His elation with locomotion wanes, and he shifts to a wish for social interaction with his mother and with other children. For both boys and girls, the discovery of anatomical differences produces a sense of their own bodies. For girls, the penis symbolizes what other children have that they cannot get, and for both boys and girls a claim to gender identity ensues. The child shows a characteristic negativity toward mother, which results both from a sense of expanded autonomy and more intense recognition of the father.

The child reacts more strongly to mother’s absence, not with low-keyedness, but with increased activity and restlessness. Both responses indicate sadness, but the activity is seen as a defense instituted against that painful emotion. The child can now cope better and can relate to substitute adults and engage in symbolic play to master the separation experience. The period of early rapprochement ends at about 18 months and appears to be a temporary consolidation and acceptance of separation; however, harbingers exist of impending crisis, including almost ubiquitous temper tantrums, vulnerability, rage, helplessness, recurrence of stranger reactions, and beginning loyalty conflicts between mother and others.

As awareness of separateness grows, there is an increased need for the object’s love. This constitutes the basis for rapprochement. During this period there is a strong need for optimal emotional availability of the mother. It is the mother’s love of the toddler and her acceptance of his ambivalence that enables him to cathect his self-representation with neutralized energy. The father is of special importance also during this period.

Shadowing and darting away are two behaviors characteristic of this subphase and indicate the wish for reunion and the fear of reengulfment. Concomitant with the acquisition of skills and perceptual cognitive capacities, there has been an increasingly clear differentiation of the intrapsychic representations of object and self; thus, the toddler must cope with the world of his own, as a small, helpless, separate individual, unable to command relief merely by feeling the need for it.

The rapprochement crisis proper occurs from about 18 to 22 months and is characterized by conflicts deriving from the desire to be separate, grand, and omnipotent, and yet have the mother fulfill wishes without having to recognize that help comes from the outside. The child’s mood changes to one characterized by dissatisfaction, insatiability, temper tantrums, and, especially, ambivalence. The mother is used as an extension of the self to deny separateness. The mother, too, shows anxiety about separation, and where mother is dissatisfied with her child, or anxious about him, or aloof from him, the normal rapprochement patterns become exaggerated.

During this period the child shows a realization of his own limitations and relative helplessness. A new capacity for empathy and higher level identifications develops. The child is especially aware of and sensitive to his mother’s whereabouts. Piaget’s (1952) object permanence is already achieved, so the child can conceive of mother being elsewhere and found again, which is often reassuring; but may demonstrate difficulty in leave taking from their mothers, with clinging behaviors and depression. Splitting as a defense is now possible. Other people become the bad mother; the good mother is longed for, but exists in fantasy only, and the real mother becomes a source of dissatisfaction on her return, leading the child either to ignore the returning mother or to avoid her.

As the rapprochement crisis is resolved, the child finds an optimal distance from mother, exercising autonomy and sociability and avoiding the ambivalence that proximity to mother might bring. By this age, children reveal less phase-specific behavior and more individual differences. Boys and girls seem very different for the first time, with boys being more disengaged from mother and girls being more engaged with her, demanding closeness in an ambivalent fashion and blaming her for the lack of the penis. Boys are less overly concerned with sexual differences.

The developmental tasks for the child at the height of the separation-individuation struggle are enormous. Conflicts about oral, anal, and early genital drives all meet, and in addition there is a need to renounce symbiotic omnipotence. The belief in the mother’s omnipotence, too, is shaken. Superego development begins with the intensified vulnerability to the threat of losing the object’s love. Where development has been less than optimal, the ambivalence conflict in relation to mother that became discernible during the rapprochement subphase is unresolved, as revealed in rapidly alternating clinging and negativistic behaviors. These reflect an ambitendency not yet internalized. Excessive splitting may be revealed as well.

The Fourth Subphase: Consolidation of Individuality and Beginning of Emotional Object Constancy (24-26 Months and Beyond)

The tasks of this subphase are the achievement of definite, and in some ways lifelong, individuality, the attainment of a certain degree of object constancy, and structuralization of the ego and beginning development of the superego.

The establishment of object constancy depends on the gradual internalization of a constant, positively cathected image of the mother. It depends also on the cognitive attainment of object permanence, a stable sense of the entity (self-boundaries), and a primitive consolidation of gender identity. Necessary attainments include as well unification of good and bad objects into whole object representations, fusion of aggressive and libidinal drives, tempering of hatred for the object when aggression is intense, and not rejecting the love object for another when the former is no longer satisfying.

Separations from the mother during the fourth, open-ended subphase are influenced by the degree of ambivalence in the relationship. When mother’s leaving stirs up expressed or unexpressed anger and longing, the child cannot easily maintain her image in his mind. During this period, verbal communication develops rapidly, play becomes more purposeful and constructive, and fantasy play, role play, and make believe are initiated. A sense of time develops, along with the capacity to tolerate delay of gratification. The child is resistant to demands of adults and often reveals an unrealistic wish for autonomy. The re-current mild or moderate negativism of this period is essential to the establishment of identity. Individuation proceeds.

During the earlier part of this subphase, the less predictably reliable or more intrusive the love object, a more does this object remain or become an unassimilated foreign body, a bad introject, and child shows an increased tendency to identify and confuse the self-image with this bad introject. In such cases, during the rapprochement, aggression sweeps away the good object and the good self-representation, as is indicated by an increase of temper tantrums and increase of coercion of mother to function as an external ego. Marked ambivalence may ensue, marring development toward object constancy and sound secondary narcissism.

The mother should be available to the child as a mental representation in the mother’s absence, the first basis of this availability being the actual mother-child relationship. Threats to the establishment of object constancy and separate individual functioning stem from the pressure of drive maturation, confronting the child with new tasks (for example, toilet training) and new fears (for example, castration fears). Mahler demonstrates that these fears affect budding object constancy and self-development, particularly when there is developmental trauma. The achievement of both object constancy and individuality is easily challenged by struggles around toilet training and by awareness of anatomical differences, which awarenesses pose a threat to the girl’s narcissism and the boy’s body integrity.


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