Julie, at the time I knew her, had been a patient in a ward of a mental hospital since the age of seventeen, that is, for nine years. In these years, she had become a typical ‘inaccessible and withdrawn’ chronic schizophrenic. She was hallucinated, given to posturing, to stereotyped, bizarre, incomprehensible actions; she was mostly mute and when she did speak it was in the most ‘deteriorated’ ‘schizophrenese’. On admission, she had been diagnosed as a hebephrenic and given a course of insulin, without improvement, and no other specific attempts had been made to recall her to sanity. Left to herself, there is little doubt she would quickly have become physically entirely ‘dilapidated’, but her outward appearance was maintained by the almost daily attentions of her mother, in addition to the work of the nursing staff.
On account of various odd and somewhat alarming things she said and did at the time, her parents had taken her to see a psychiatrist when she was seventeen. In her interview with the psychiatrist, he recorded that there was nothing particularly unusual about her non-verbal behaviour in itself but that the things she said were enough to establish the diagnosis of schizophrenia. In clinical psychiatric terminology, she suffered from depersonalization; derealization; autism; nihilistic delusions; delusions of persecution, omnipotence; she had ideas of reference and end-of-the-world phantasies; auditory hallucinations; impoverishment of affects, etc.
She said the trouble was that she was not a real person; she was trying to become a person. There was no happiness in her life and she was trying to find happiness. She felt unreal and there was an invisible barrier between herself and others. She was empty and worthless. She was worried lest she was too destructive and was beginning to think it best not to touch anything in case she caused damage. She had a great deal to say about her mother. She was smothering her, she would not let her live, and she had never wanted her. Since her mother was prompting her to have more friends, and to go out to dances, to wear pretty dresses, and so on, on the face of it these accusations seemed palpably absurd.
However, the basic psychotic statement she made was that ‘a child had been murdered’. She was rather vague about the details, but she said she had heard of this from the voice of her brother (she had no brother). She wondered, however, if this voice may not have been her own. The child was wearing her clothes when it was killed. The child could have been herself. She had been murdered either by herself or by her mother, she was not sure. She proposed to tell the police about it.
We can see the existential truth in Julie’s statements, made when she was seventeen, that she is not a person, that she is unreal, and we can understand what she was getting at when she said that she was trying to become a person, and how it may have come about that she felt at once so empty and so powerfully destructive. But beyond this point, her communications become ‘parabolic’. Her accusations against her mother, we suspect, must relate to her failure to become a person but they seem, on the surface, rather wild and far-fetched. However, it is when she says that ‘a child has been murdered’ that one’s common sense is asked to stretch further than it will go, and she is left alone in a world that no one will share.
Now, I shall want to examine the nature of the psychosis, which appeared to begin about the age of seventeen, and I think this can best be approached by first considering her life until then. I saw the mother once a week over a period of several months and interviewed (each on a number of occasions) her father, her sister, three years older, who was her only sibling, and her aunt (father’s sister). Father, mother, sister, aunt were the effective personal world in which this patient grew up. Although each of the various people interviewed had his or her own point of view on Julie’s life, they all agreed in seeing her life in three basic states or phases. Namely, there was a time when,
1. The patient was a good, normal, healthy child; until she gradually began
2. to be bad, to do or say things that caused great distress, and which were on the whole ‘put down’ to naughtiness or badness, until
3. this went beyond all tolerable limits so that she could only be regarded as completely mad.
Once the parents ‘knew’ she was mad, they blamed themselves for not realizing it sooner. Her mother said: I was beginning to hate the terrible things she said to me, but then I saw she couldn’t help it. She was such a good girl. Then she started to say such awful things. If only we had known. Were we wrong to think she was responsible for what she said? I knew she really could not have meant the awful things she said to me. In a way, I blame myself but, in a way, I’m glad that it was an illness after all, but if only I had not waited so long before I took her to a doctor. What is meant precisely by good, bad, and mad we do not yet know. But we do now know a great deal. To begin with, as the parents remember it now, of course, Julie acted in such a way as to appear to her parents to be everything that was right. She was good, healthy, normal. Then her behaviour changed so that she acted in terms of what all the significant others in her world unanimously agreed was ‘bad’ until, in a short while, she was ‘mad’.
This does not tell us anything about what the child did to be good, bad, or mad in her parents’ eyes, but it does supply us with the important information that the original pattern of her actions was entirely in conformity with what her parents held to be good and praiseworthy. Then, she was for a time ‘bad’, that is, those very things her parents most did not want to see her do or hear her say or to believe existed in her, she ‘came out with’. We cannot at present say why this was so. But that she was capable of saying and doing such things was almost incredible to her parents. All that emerged was totally unsuspected. They tried at first to discount it, but as the offence grew they strove violently to repudiate it. It was a great relief, therefore, when, instead of saying that her mother wouldn’t let her live, she said that her mother had murdered a child. Then all could be forgiven. ‘Poor Julie was ill. She was not responsible. How could I ever have believed for one moment that she meant what she said to me? I’ve always tried my best to be a good mother to her.’ We shall have occasion to remember this last sentence.
These three stages in the evolution of the idea of psychosis in members of a family occur very commonly. Good—bad—mad. It is just as important to discover the way the people in the patient’s world have regarded her behaviour as it is to have a history of her behaviour itself. I shall try to demonstrate this conclusively below, but at this point I would like to observe one important thing about the story of this girl as told me by her parents. They did not suppress facts or try to be misleading. Both parents were anxious to be helpful and did not deliberately, on the whole, withhold information about actual facts. The significant thing was the way facts were discounted, or rather the way obvious possible implications in the facts were discounted or denied. We can probably best present a brief account of this girl’s life by first grouping the events together within the parents’ framework. My account is given predominantly in the mother’s words.
Julie was never a demanding baby. She was weaned without difficulty. Her mother had no bother with her from the day she took off nappies completely when she was fifteen months old. She was never ‘a trouble’. She always did what she was told. These are the mother’s basic generalizations in support of the view that Julie was always a ‘good’ child. Now, this is the description of a child who has in some way never come alive: for a really alive baby is demanding, is a trouble, and by no means always does what she is told. It may well be that the baby was never as ‘perfect’ as the mother would like me to believe, but what is highly significant is that it is just this ‘goodness’ which is Mrs X’s ideal of what perfection is in a baby. The crucial thing seems to me to be that Mrs X evidently takes just those things which I take to be expressions of an inner deadness in the child as expressions of the utmost goodness, health, normality. The significant point, therefore, if we are thinking not simply of the patient abstracted from her family, but rather of the whole family system of relationships of which Julie was a part, is not that her mother, father, aunt all describe an existentially dead child, but that none of the adults in her world know the difference between existential life and death. On the contrary, being existentially dead receives the highest commendation from them.
Let us consider each of the above statements of the mother in turn.
1) Julie was never a demanding baby. She never cried really for her feeds. She never sucked vigorously. She never finished a bottle. She was always ‘whinie and girnie’ [peevish]; she did not put on weight very rapidly. ‘She never wanted for anything but I felt she was never satisfied.’ Here we have a description of a child whose oral hunger and greed have never found expression. Instead of a healthy vigorous expression of instinct in lusty, excited crying, energetic suckling, emptying the bottle, followed by contented satiated sleep, she fretted continually, seemed hungry, yet, when presented with the bottle, sucked desultorily, and never satisfied herself. It is tempting to try to reconstruct these early experiences from the infant’s point of view, but here I wish to restrict myself only to the observable facts as remembered by the mother after over twenty years, and to make our constructions from these alone.
As stated above, and this is I believe an important point when thinking of aetiological factors, one of the most important aspects of this account is not simply that we get the picture of a child who, however physically alive, is not existentially becoming alive, but that the mother so far misunderstands the situation that she continues to rejoice in the memory of just those aspects of the baby’s behaviour which were most dead. The mother is not alarmed that the baby did not cry ‘demandingly’ nor drain the bottle. That Julie did not do so, is not sensed by her as an ominous failure of basic oral instinctual drives to find expression and fulfilment but solely as token of ‘goodness’.
Mrs X repeatedly emphasized that Julie had never been a ‘demanding’ baby. This did not mean that she was not a generous person herself. In fact, she had ‘given her life’ for Julie, as she put it. As we shall see, Julie’s sister had been a demanding, greedy baby. Her mother had never had much hope for her: ‘I just let her go her own way.’ However, it was just the fact that Julie from the start had never been demanding that seemed largely to have encouraged her mother to give her so much, as she had done. It was therefore a terrible thing for her when, in her teens, Julie, instead of displaying some gratitude for all that had been done for her and given to her, began to accuse her mother of never having let her be. Thus, although it seems to me quite possible that, owing to some genetic factor, this baby was born with its organism so formed that instinctual need and need-gratification did not come easily to it, put in the most general way, added to this was the fact that all the others in its world took this very feature as a token of goodness and stamped with approval the absence of self-action. The combination of almost total failure of the baby to achieve self-instinctual gratification, along with the mother’s total failure to realize this, can be noted as one of the recurrent themes in the early beginnings of the relation of mother to schizophrenic child.
2) She was weaned without any trouble. It is in feeding that the baby for the first time is actively alive with another. By the time of weaning the ordinary infant can be expected to have developed some sense of itself as a being in its own right, it has a ‘way of its own’, and some sense of the permanence of the mother as prototypical other. On the basis of these achievements, weaning occurs without much difficulty. The baby at this stage is given to playing ‘weaning games’ in which he drops, say, a rattle, to have it returned to him; drops it again, to have it returned; drops it, and so on, interminably. The baby seems here to be playing at an object going away, returning, going away, returning, the central issue of weaning in fact. Moreover, the game has usually to be played his way so that we find it ‘natural’ to collude with him in maintaining the impression that he is in control.
In Freud’s case, the little boy kept his reel of string attached to him when he threw it away, in contrast to the fact that he could not keep his mother thus under control by an attachment to her ‘apron strings’. Now, if, as we have inferred, this girl was, in early months, not achieving the autonomy that is the prerequisite for the ability to go one’s own way, to have a mind of her own, then it is not surprising that she should appear to be weaned without difficulty, although it could hardly be called weaning when the infant is giving up something it has never had. In fact, one could hardly speak of weaning having occurred at all in Julie’s case. Things went so smoothly at this time that her mother could recall very few actual incidents. However, she did remember that she played a ‘throwing away’ game with the patient. Julie’s elder sister had played the usual version of this game and had exasperated Mrs X by it. ‘I made sure that she (Julie) was not going to play that game with me. I threw things away and she brought them back to me,’ as soon as she could crawl. It is hardly necessary to comment on the implications of this inversion of roles for Julie’s failure to develop any real ways of her own.
She was said to have been precocious in walking (just over one year), and would scream if she could not get to her mother across the room quickly enough. The furniture had to be rearranged because ‘Julie was terrified of any chairs that came between her and me’. Her mother interpreted this as a token of how much her daughter had always loved her. Until she was three or four, she ‘nearly went crazy’ if her mother was out of her sight for a moment. This seems to lend confirmation to the suggestion that she was never really weaned because she had never reached a stage when weaning, in any more than a physical sense, could take place. Since she had never established an autonomous self-being, she could not begin to work through the issues of presence and absence to the achievement of the ability to be alone by herself, to the discovery that the physical presence of another person was not necessary for her own existence, however much her needs or desires may have been frustrated. If an individual needs another in order to be himself, it presupposes a failure fully to achieve autonomy, i.e. he engages in life from a basically insecure ontological position. Julie could be herself neither in her mother’s presence nor in her absence. As far as her mother remembers, she was never actually physically out of earshot of Julie until she was almost three.
3) She was clean from the moment that nappies were taken off at fifteen months. One may note at this point that it is not unusual to find in schizophrenics a precocious development of bodily control although it is not known how they compare with others in this respect. One is certainly often told by parents of schizophrenics of how proud they were of their children because of their precocious crawling, walking, bowel and bladder functioning, talking, giving up crying, and so on. One has to ask, however, in considering the conjunction between what the parent is proud to tell about and what the child has achieved, how much of the infant’s behaviour is an expression of its own will. The question is not how good or how naughty a child is, but whether the child develops a sense of being the origin of his own actions, of being the source from which his actions arise: or whether the child feels that his own actions are generated not from within himself, but from within the mother, despite possibly giving every appearance of being the agent of his acts. It can happen that the body may perfect its skills and thus do all that is expected of it; yet genuine self-action seems never to have become established to any extent, but instead all action is in almost total compliance and conformity with outside directives. In Julie’s case, her actions appear to have been trained by her mother, but ‘she’ was not ‘in’ them. This must have been what she meant by saying that she had never become a person and in her constant reiteration as a chronic schizophrenic that she was a ‘tolled bell’ (or ‘told belle’). In other words, she was only what she was told to do.
4) She always did what she was told. As we remarked earlier about telling the truth and lying, there are good reasons for being obedient, but being unable to be disobedient is not one of the best reasons. So far, in Mrs X’s account one is unable to see that the mother recognized in Julie any possibilities other than her being what Julie herself called ‘the told belle’. She ‘gave her life’ to the tolled bell, but she totally denied, and still did twenty-five years later, the possibility that this good, obedient, clean little girl, who so loved her that she nearly went crazy when separated from her if only by a chair, was petrified into a ‘thing’, too terror-stricken to become a person.
5) She was never a ‘trouble’. It was now clear that from the time that this patient emerged beyond the early months of life she was without autonomy. She had never, as far as can be judged from what her mother remembers, developed ways of her own. Instinctual needs and gratifications had never found any expression through channels of bodily activity. Real satisfaction arising from real desire for the real breast had not occurred in the first instance. Her mother regarded the consequences of this with the same approval as she did its first manifestations. ‘She would never take too much cake. You just had to say, “That’s enough, Julie”, and she wouldn’t object.’ We noted earlier how it may come about that hatred is expressed only in and through the very compliance of the false-self system. Her mother commended her obedience, but Julie began to carry her obedience to such lengths that it became ‘impossible’. Thus, she had a spell, at about the age of ten, when she had to be told everything that was going to happen in the course of the day and what she was to do. Every day had to begin with such a catalogue. If her mother refused to comply with this ritual she would start to whimper. Nothing would stop this whimpering, according to her mother, but a sound thrashing. As she grew older, she would not use any money she was given herself. Even when encouraged to say what she wanted or to buy a dress herself or to have friends like other girls, she would not express her own wishes; she had to have her mother to buy her clothes, and she showed no initiative in making friends. She would never take a decision of any kind.
Besides the whimpering mentioned above, there were a few other occasions in childhood when Julie upset her mother. She had a spell during the years from five to seven when she bit and tore at her nails; from the first beginnings of speech she had a tendency to turn words round back to front. Suddenly, at the age of eight, she started to overeat, and continued in this for some months before reverting to her usual half-hearted way of eating. Her mother, however, discounted such things as transitory phases. One has in them, nevertheless, sudden glimpses of an inner world of violent destructiveness with a short-lived desperate access of manifest greed which, however, soon became curbed and submerged again.
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By Richard Jonathan | © Mara Marietta Culture Blog, 2021| All rights reserved