Winnicott saw how mental health problems could arise in later life if the environment of the infant were not ‘good enough’. This essay will look at what this is and the trauma that arises from ‘not good enough mothering.’ Winnicott (cited in Mitchell and Black, 1995, p125) used the phrase “environmental deficiency disease” to make the point that mental health problems like psychosis, depression or addiction were the symptoms of a disease that lies within. The term, ‘good enough mothering’, is what Winnicott believed was required to nurture a child into an emotionally healthy adult. The mental and physiological impacts of trauma often lead to loneliness. Loneliness can lead to addiction. This is one path that leads from traumatised infant to addicted adult trying to survive in an isolating environment. The parallels between Winnicott’s ‘environmental mother’ will be compared with the parallels of the adult environment that Johan Hari believes is not serving us anymore. Of course, there are many ways that a child can become addicted in adulthood, but these steps seem to be the most common in our society:
Not good enough mother > trauma > incapacity to be alone or to connect > depression & anxiety > addiction.
In writing this essay, addiction is referred to as one uniform entity. As one of the world’s most experienced experts on addiction Maté (2008, p129) says “all addictions—whether to drugs or non-drug behaviours—share the same brain circuits and brain chemicals.“ The intention of the heroin addict is the same as the compulsive shopper: to change the physiological state of their brain. Maté (2010, p36) says that “a hurt is at the centre of all addictive behaviours.” The size of the hurt may differ, but it is still there. Like Winnicott, Maté has seen that “the effects of early stress or adverse experiences directly shape both the psychology and neurobiology of addiction in the brain.” These two are indeed in agreement that addiction is a problem of nurture rather than nature. When one is suffering from a common cold, one may have many different symptoms from a blocked nose to a cough. What one sees on the outside is coughing, but we know that inside, this is caused by a virus (Kolk, 2014). This is the same for addiction. On the outside, we might see someone injecting heroin or gambling their house away. Inside is not a virus, but pain.
Maté (2008, p33) believes that “addicts are self-medicating conditions like depression, anxiety, post-traumatic stress or even ADHD.” In our highly medicalised society, when one has the symptom of pain, they are given something to numb it. So, when we talk about addiction, we are not talking about a completely separate diagnosis. We are talking about a solution to a problem: the numbing of pain. While this solution may not be the healthiest; if we look at it this way, we can understand the addict’s rationale. Maté’s (2008, XI) question is never “why the addiction” it is always, “why the pain?” Just as our doctors over-prescribe painkillers causing lasting damage to the gut-lining, the addict follows the same advice with their addiction. The prescription for depression or addiction has not been to heal the trauma, but to numb the pain. The pain is there for a reason. It is telling us that we need to change something in ourselves or our environment (Hari, 2018). A therapist’s role can be to help the client feel their pain and work through it.
To find out where the pain comes from it is best to start at the beginning. This is where Winnicott focused his attention; on the earliest days of an infant’s life. When Winnicott famously said, “there is no such thing as a baby” he was trying to emphasise the importance of the mother. He meant that “a baby cannot exist alone but is essentially a part of a relationship” (Winnicott, 1947). Separation for the baby or the adult can mean death.
Both Winnicott and his predecessor Melanie Klein moved the focus of psychoanalysis onto the earliest development of the infant. However, Winnicott believed that the infant is a social being from birth whereas Klein distilled this to merely a desire for instinctual gratification from an object. Winnicott contested that “it is not instinctual satisfaction that makes a baby begin to be, to feel that it is real, to find a life worth living” (Winnicott, 1967, p116) but the essential care provided by the mother.
In his work, Winnicott provided several vital roles that the mother must fill. Winnicott (1947) stated that an infant’s physical and emotional growth is dependent upon a ‘facilitating environment’. By this, he meant the mother herself. The mother was more than just another human who cared for the baby; she was the whole environment. She provided all the physical and emotional needs of the baby and also reflected the world into the baby’s eyes.
The mother must provide protection from environmental impingements. E.g. the head not being supported, loud noises, repeated changes in technique or abandonment. Environmental impingements can be traumatic if they interrupt what Winnicott called ‘going on being.’ If there are frequent environmental impingements during the stage of ‘absolute dependence’, then the risk of later mental health issues increases (Karnac, 1991). If the environment is ‘good enough’, the child will begin to develop the capacity to gather the impingements ‘into the area of omnipotence’ and make the unpredictable, predictable. For the therapist, these concepts can apply to the ‘frame’. Maintenance of predictable time boundaries would demonstrate this.
Just as Winnicott suggested, a study conducted by Shroufe (cited in Kolk, 2014, p161) showed that children regularly pushed into “overarousal and disorganisation did not develop proper attunement of their inhibitory and excitatory brain systems. By late adolescence half of them had diagnosable mental health problems.” The use of the term ‘disorganisation’ is associated with Bowlby. While the language may remind us of Bowlby, the words ‘overarousal’ could be substituted for ‘interruption of going on being’. Bowlby and Winnicott stand in the space between the traditional drive-based psychoanalysis and relational-based theory. Bowlby shared Winnicott and Hari’s view that separation from people essential to survival would be catastrophic (Gomez, 1997). Bowlby would suggest that the reaction to this would be mourning, whereas Winnicott and Hari might see the reactions develop into psychosis or depression.
Combined with the protection from the environment, the baby requires ‘holding’. Holding included both the physical aspect of picking up a baby, plus meeting all the baby’s other physical needs. For physical needs to be understood, the mother needs empathy (Karnac, 1991). The mother must psychically tune into the baby, read its emotions and then meet the need. The inference of a psychic connection is reminiscent of Bion. He believed that this bond was an evolutionary survival mechanism that allowed communication before words were possible (Mitchell & Black, 1995). Similarly, empathy, holding and containment are all functions that the therapist must utilise to support their client.
The infant’s ego begins life as immature and weak but through the mother’s ‘ego-support’ and ‘holding’ it is made strong. By cultivating this mother-child bond, the child learns to trust the mother and the environment. This special relationship is what Winnicott called ‘ego-relatedness.’ This term was essential to differentiate the concept from the id-instincts that Winnicott’s predecessors in psychoanalysis developed.
What Winnicott and Bion called ‘ego-relatedness’ and empathy, might now be explained by the discovery of mirror neurons. Mirror neurons develop in the frontal lobe of the brain. They allow us to read people’s emotions and intentions. They help to explain why the baby is so vulnerable. We can read someone else’s anger and respond with negativity, and we can also be dragged down by reading their depression. In a familiarly Winnicottian way, Kolk (2014, p58) states that “trauma almost invariably involves not being seen, not being mirrored and not being taken into account.” Without a mother to demonstrate what emotional mirroring looks like the frontal lobe does not fully develop and the child will not be able to interact successfully with others. Kolk (2014, p60) asserts that “without flexible and active frontal lobes people become creatures of habit, and their relationships become superficial and routine.” The role of the therapist should be to demonstrate healthy mirroring so the client can feel connected and also learn these skills for themselves.
Winnicott believed that we are never totally independent. Karnac (1991) summarises how Winnicott saw infant growth in stages, from ‘Absolute Dependence’ to ‘Relative Dependence’ ending at a stage he called ‘Towards Independence.’ Notice that this is not complete independence but specifically a movement towards it. The child reaches the third stage if he has an “accumulation of memories of care, the projection of personal needs and the introjection of care details, with the development of confidence in the environment” (Winnicott, 1960). The child who has this ability has a template to use for the rest of their life. When they start interacting with other children, they can tell a game from reality. They become good playmates; they learn to be in tune with other people and become valued members of society in an upward spiral.
Conversely, the spiral can turn downwards. Unable to read the voices and emotions of their playmates, they overreact to aggression, become bad losers or shut down quickly. They then get shunned for playdates. They spend more time alone watching YouTube and falling even further behind with social skills (Kolk, 2014.) Their isolation increases and loneliness follows.
The mother must teach the baby how to rest when alone as well as how to connect. Winnicott theorised that “rest for the infant means a return to the un-integrated state” (Winnicott, cited in Karnac, 1991). This is enabled by a mother who provides ‘ego-support’. Un-integration is a state of “being calm, restful, relaxed and feeling one with people and things when no excitement is around” (Winnicott, cited in Karnac, 1991). To an addicted adult, this state may never be possible. “The capacity to be alone” (Winnicott, 1958) is vital for a person to recuperate without the adverse effects of loneliness.
A study by Cacioppo et al. (2009) portrays what it is like to be someone unable to rest in the un-integrated state. In this study, they put people who described themselves as lonely and people who said they felt ‘socially connected’ into a brain scanning machine. They saw that lonely people would spot a potential threat within 150 milliseconds and the socially connected people would take as long as 300 milliseconds. The lonely people know that no one is looking out for them, so they have to do it themselves. Many of Kolk’s (2014) most treatment-resistant patients have benefited from new techniques like neuro-feedback, and EMDR and Maté is an advocate for psychedelic-assisted psychotherapies like ayahuasca. These treatments are currently receiving a great deal of press and research. Of particular interest to the therapist may be psilocybin mushrooms which have just been categorised as a ‘breakthrough therapy’ for treating depression and 3,4-methylenedioxymethamphetamine (MDMA) which is now prescribed for the treatment of PTSD in the USA. Criticism of Winnicott from the likes of Bateman and Holmes (1995) suggests that simply creating a ‘holding environment’ is not enough for some clients. Tools such as those above could make valuable additions to what the therapist can offer.
A further problem that arises from ‘not good enough mothering’ is the development of ‘The False Self.’ This development happens at the time of absolute dependence if there was a failure in object-presenting and the mother is unable to allow the child to feel omnipotent. The child is made to feel omnipotent if its cries for milk are met with milk; its cries for sleep are met with sleep. If the mother can meet and make sense of these omnipotent expressions, she will give strength to their immature ego and a “True Self” will emerge. The ‘not good enough mother’ will not be able to understand the omnipotent gestures and will instead try to force her own gestures onto the baby. The weak baby has no choice but to comply with being fed when it is not hungry, and this compliance makes the mother think that the child is okay. This compliance is the ‘False-Self’ (Winnicott, cited in Karnac, 1991). Sroufe has seen that when there is, what he calls, "an inflexible parent, the child becomes clingy and uptight." His study has shown that "the more insensitive, pushy and intrusive the parent is at six months, the higher the chance of producing a child with attention disorders and hyperactivity" (Sroufe & Jacobvitz, 1987). These pushy interjections could be where the addict learns to substitute one need with another.
From Freud to Kolk, trauma has always been seen as the root cause of mental health problems. Winnicott’s predecessors looked to the ‘internal drivers’ as the source of trauma. Freud was particularly interested in the three-person relationship and the ‘Oedipus Complex’ (Phillips, 1988). ‘The Object Relations Theorists’ focused on the helplessness of the infant and the relationship to the mother. For Winnicott, environmental impingements caused trauma. While there may be disagreement on these theories, there is no disagreement that childhood trauma needs resolution in the adult or better still: prevention.
In a rat experiment, Meaney et al. (cited in Kolk, 2014, p152) showed the life-long physiological effects of a ‘good enough mother’. The more the mother licked a new-born rat pup during the first twelve hours after birth, the braver they were and the lower levels of stress hormones they produced. Not only during the early hours but for the rest of their lives. They also found that over a thousand genes were modified and their hippocampus, a vital centre for learning and memory, developed thicker connections.
We have seen clinical and theoretical evidence of the damage trauma does in the child, on top of this, loneliness itself causes physiological damage: in fact, it causes cortisol levels to rise as much as a physical attack (Cacioppo, 2010). The reason loneliness is such a problem is that when we were living in tribes, separation could mean death. Loneliness is accompanied by anxiety because our biology is telling us we must find our tribe. As we have seen mental health problems rise over the last few decades, it is no surprise to see statistical proof of loneliness rising. Researchers asked how many people someone could call in a crisis. In 1985 the most common answer was three. In 2006 the most common answer was zero (McPherson et al., 2006). Loneliness may not lead directly to death anymore, but it can lead to depression, anxiety and addiction.
Addictions that ruin lives can seem confusing at first. When Marianne Faithful famously said, “heroin saved my life” (Hawksley, 2019) a typical reaction may have been disbelief. The media portrays heroin as an unequivocal evil. Faithful was highlighting that it was not the drugs themselves that were the problem; it was her environment. There is a war on drugs; heroin is right in the centre of that. If heroin is to blame for addiction then why don’t we look at gambling addiction and call a deck of cards evil (Maté, 2008)? The research is clear - addiction is not something that the weak-willed do for pleasure; most hard-core substance addicts grew up in abusive homes (Shanta, 2003).
A study known as ‘Rat Park’, (Alexander et al.,1981) demonstrates how the environment contributes to addiction. Here they compared the morphine addiction rates in rats either housed in cages or an ideal rat environment full of open space, flowing water and social interactions. With the rats housed in a healthy environment, Alexander stated that “nothing that we tried instilled a strong appetite for morphine or produced anything that looked like an addiction”. The caged rats consumed up to twenty times more morphine than those in Rat Park.
Darwin may have said that this was merely a case of ‘survival of the fittest.’ Rats or humans who are not able to adapt to the environment are not fit for survival. With the word 'environmental', you can see Darwin’s influence on Winnicott. Darwin had realised that the organism must comply with the demands of the environment. Winnicott transposed the relationship between the natural environment and the evolving animal onto the mother and the child. The mother, as the first environment, must adapt for the child to have its needs met and survive (Phillips, 1988).
In the adult environment, Hari (2018) proposes that we have created a society that does not enable everyone to survive. Unlike the animals Darwin observed, humans have the power to change their environment. One has to be aware of one's own biases when writing about such controversial topics. As a recovering addict, there is a desire to refute the Darwinian interpretation and find evidence as to why it is not my fault. There is a desire to convince people that parents and society should be blamed. However, in changing my environment to incorporate Hari's recommendations like reconnecting with nature, disconnecting from technology and spending more time socialising, coupled with personal therapy, my life has improved. Therapists need to be aware that their psychological work in a short, weekly session may not be enough and that helping clients to change their environment in addition to therapy has value.
Winnicott, Hari, Maté and Kolk were all speaking about the Western Societies where they lived and cannot speak for every culture. However, we can see similar discontent around the world with the Indian philosopher J. Krishnamurti who famously said, “it is no measure of health to be well-adjusted to a profoundly sick society” (cited in Hari, 2018, p156).
The socio-political environment that Winnicott was working in may also have created a bias that led him to understate the importance of the father. In the following quote, we can see how Winnicott (Cited in Karnac, 1991, p107) mentions the father almost as an afterthought. He says that perfect care of the child is neither possible nor necessary. That “the infant needs what he usually gets, the care and attention of someone who is going on being herself. This applies to fathers too.” With the arrival of Klein and Anna Freud into the UK, there was a shift in psychoanalysis from Sigmund Freud’s focus on sexual drives to theories about emotional relationships. The next shift came with Winnicott and Bowlby after World War II. During the war, women in England needed to leave the home to work. At the end of the war women needed to migrate back. It may have been that Winnicott and Bowlby were trying to ease this transition by over-emphasising the importance of the mother (Phillips, 1988). There is also a belief that Winnicott’s mother suffered from depression when he was a child. A poem titled ‘The Tree’ (Kahr, 1996) is evidence of this. This depression, coupled with limited contact with his father, may have created an urge to change memories of his childhood by distorting the mother/father significance.
Winnicott’s quote from the last paragraph also assures mothers that their job is not impossible. With all addiction and mental health problems, it does not serve anyone to lay blame at the feet of the mother. Like Winnicott, Maté (2018, XXIV) agrees that “suffering is multi-generational” and that it will be passed “on unwittingly until we understand it and break the links in the chain of transmission within each family.” All parents do their best, but their “best is limited by [their] own unresolved or unconscious trauma.”
In an attempt to highlight the root causes of addiction, there is an urge to distil addiction into a simple problem consisting of early trauma plus an insufficient environment. This does not do justice to the vast scope of possible influences on addiction. Its causes are a combination of genetics, biology, neurology, psychology, emotions, sociology, politics, economy and spirituality (Maté, 2008). When one considers these factors, it can seem like an overwhelming problem. However, in looking at childhood trauma and the environment, we can at least try to understand part of the problem. Modern research methods are now supporting Winnicott's theories, which is encouraging. However, it is sad to see that mental health problems have only risen since Winnicott was working.
Social interactions require compliance without being exposed. As we have seen, many addicted people will not be able to do this without further trauma. The role of therapy needs to be providing a ‘good enough environment’ where the adult can feel safe to feel their pain. They need to be mirrored and held in order to develop the skills required to connect and heal. With these skills, they can create healthier environments. Continued research into areas like psychedelics and neurofeedback will also add to the number of tools a therapist can offer to the most treatment resistant.
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