Inside Margot Wadell – Book Review: Inside Lives

This is a review written back when I was studying psychoanalysis. These articles critiquing psychodynamic texts proved pretty popular (I’m assuming with students, or practicing psychoanalysts) when I initially posted them. Having recently uncovered a couple that had never made their way to the web, I thought why not release them. Hope you find them useful / interesting, despite the rather dense academese.

Stuck Inside, by Norman Rockwell.
Stuck Inside, by Norman Rockwell.

Inside lives (Waddell, 2002) attempts a phenomenological object relations account of psychological development, from infancy to advanced age. Margot Waddell considers the stages of life as states or meta-positions (Waddel, 2002, pp 8), contingent and dependent on earlier developmental negotiation, rather than inevitable developmental milestones. These states represent individuated matrixes of attitude and biological development, in which the positions articulated by Klien and others shift in the context of emotional and intellectual development, external stressors and interpersonal relations. The book examines the impact of biological changes, family of origin, adolescent affiliation, adult individuation and finally the difficulties of coping with degeneration and impending mortality.

In situating development in a flux of regression, premature adoption of maturity, and ‘oscillation’ to infantile insecurities, Waddell attunes us to inner chaos that can be concealed in high functioning adults. Her focus on development helps to outline how psychodynamics reveal themselves in child and infant clients, manifesting as elements of introjected parental dysfunction, socially transmitted persona, and as aspects of an ‘authentic self’. In the processes Waddell provokes interesting questions, for example about the degree to which ‘learning difficulties’ may be a product of avoidant anxiety rather than inadequate capacity.

Similarly, Waddell’s explanation of the process by which early defences become deeply embedded regressive tendencies illustrates how clients unconsciously manage anxiety by employing defences like avoidance, acting out and projection. With deeply disturbed clients, her portrayal of the ‘false’ self, adopting ‘primitive’ ‘exoskeleton’ defences produced through identification with the ‘projective-identification rejecting object’, is compelling (Waddell, 2002, 50).

Waddell’s detailing of the specific defensive processes employed, and dysfunctions exhibited in distinct developmental states like latency, provides a good preparation for the identification of client’s level of function and an understanding of how individuals can assume a cargo cult of adulthood, without a concomitant ‘engagement with experience’.

Transition of Virgin into Bride by Marcel Duchamp
Transition of Virgin into Bride by Marcel Duchamp

Waddell’s clinical examples are vivid, and help to explicate concepts like Winnecott’s ‘transitional object’ (Winnecott, 2005), and Bion’s ‘reverie’, ‘-K’ learning and ‘symbol formation’ (Bion, 1998). Waddell details the development of the individual through the lens of object relations, in the process demonstrating the vital role of infant nurturing in intellectual as well as emotional development: Providing a motivation for and an understanding of the utility of containment in psychotherapeutic practice. This internalisation of new objects, providing emotional sustenance and intellectual coherence, can be seen as the primary curative methodology of the object relations approach.

Waddell’s explanation of Bion’s ideas regarding authentic learning provide a useful understanding of how clients may employ expertise and ‘flight to language’ as dissociative approaches to anxiety management. Waddell details how these early acquired premature defences can become core elements of personality structure, and this provides a useful way to approach emotional dislocation in client work.

Waddell’s approach to interpretation follows the template of ‘unfocused listening’ (Casement, 1995), and her method of listening for the unconscious content beneath the ‘subject, verb, object’ structure of client disclosure seems immediately applicable to client work.

Waddell’s ability to provide an adequate container for the distress and distrust of deeply disturbed children is profoundly impressive. While this work seems significantly challenging, Waddell’s approach is pragmatic while at the same time privileging the meaning making processes of her clients.

Waddell is keen to consider her clients in their sociological context, but can fail to adequately address their biological and evolutionary context. An elderly client’s irrational jealousy of her husband is considered oedipal, the assumption being that the oedipal complex is the origin of, rather than one exemplar of innate adaptive (if in this case dysfunctional) sexual jealousy (Buss, 2011). Similarly her conception of ‘realistic thinking’ misses the adaptive utility of affective rationality, and the ecologically bounded nature of rationality itself (Simon, 1972). Waddell observes the social utility of neurotic positions (like –k intellectualisation), without examining their adaptive utility in the social, endophenotypic and evolutionary context. For example one of Waddell’s client’s ‘Simon’, is described as emotionally delayed through the assumption of an intellectual persona (Waddell, 2002, pp159). However, the fact that Simon’s brother is autistic makes it likely that Simon himself manifests biological impairments in emotional understanding (and at the same time benefits from enhanced information processing capabilities) typical of ‘the spectrum’ (Newschaffer et al, 2002). An examination of such factors might help to elucidate how ‘dysfunctional’ positions are supported (into adulthood) by family and social role, and help to create social institutions which perpetuate them.

Metaphysics Foetus by Wojciech Siudmak
Metaphysics Foetus by Wojciech Siudmak

Waddell’s examination of early infancy briefly explores the potential influences on personality of pre-natal experiences, considering the impact of the interuterine chemical environment, birth stresses and the pre-natal mother-child relationship. Waddell goes so far as observe re-enactments of birth trauma in infant clients and birth trauma imagery in adult clients (Waddell, 2002, pp209); however these interpretations are never linked to the considerable observational work done in this area by transpersonal psychoanalysts (Groff, 1979). Presumably this relates to the disregard for such theoretical approaches within academic psychoanalysis – however it’s worth noting that academic psychology in general considers psychoanalysis pseudoscientific (due to its lack of predictive utility, and the untestability of many of its core precepts) (Cioffi, 1998). The fascinating infant interpretations detailed by Waddell are inevitably projective, leaving the reader wondering why lines are drawn so arbitrarily around the particular level of intersubjective speculation here considered meaningful – since so much of the text is an effort to infer the (ultimately unknowable) subjective experience of infancy. For this reason Waddell’s client vignettes can at times be unconvincingly specific especially where clever clients produce psychodynamically illustrative dreams (e.g.: Simon) or when incidents in their lives eerily echo their psychodynamic process (e.g.: Laura).

Waddell’s examination of the process of learning and individuation though containment and gradual dethronement is coherent, but could have benefited from integration with Lev Vygotsky’s work on the social scaffolding of learning and the ‘zone of proximal development’ (Vygotsky, 1978), which seems to cohere with Bion’s ‘thinking breast’ (Waddell, 2002) as a frame for the coherence of fragmentary sensory experience.

Waddell’s clients frequently suffer from the experience of profoundly disturbed attachment (Waddell, 2002, pp61). Her approach to treatment could benefit from integration of research into the caregivers role in attachment. Much work in this area has examined the intergenerational transmission of attachment styles (van Ijzendoorn, 1997), and how infant attachment is expressed in adult attachment style (Hesse, 2008) in various cross cultural contexts.

More could have been said about weaning and the oedipal constellation in single parent or mixed families, which today make up more and more of the client population.

Waddell’s focus on the contingent, flexible nature of Klienian paranoid-schizoid / depressive positions suggests the possibility of other, less well articulated positions. It might have been interesting to examine more of the post-Klienian object relations literature, for examine Eric Bernes work on transactional analysis (Berne, 1996), to expand on these various ways of relating in the world. Similarly, the chapter dealing with the family could have been expanded to consider family systems models of psychodynamics (Bowen, 1993), which are more nuanced than the oedipal triad / sibling competition Waddell describes. Despite this, Waddell’s account is an interesting examination of how the developmental crises in early childhood reassert themselves in the parenting dynamic – and how this leads to the intergenerational transmission of insecure / ambivalent attachment. Again, relating this to the development of dysfunctional family roles, as children adopt labels / positions which unconsciously identify with parental projections could have been educative. None the less, Waddell’s case examples richly illustrate the complex ways in which families act to constrain and delimit the identities of their members – and her typology of various dysfunctional family types is fascinating.

Like many developmental accounts, the book is overwhelmingly concerned with the early stages of life– both in terms of age and mental functioning. While (as Waddell clearly articulates) the routes of mental dysfunction frequently lie in childhood and adolescence, this focus precludes an examination of higher levels of mental function and a more detailed view of aging and its attendant emotional process. In defining maturity as an ability to tolerate suffering, and ‘engage with experience’ (Waddell, 2002, pp 195) though the employment of internalised objects and depressive positions, Waddell ignores the tremendous importance of social relationships, creativity and self development in self-esteem and life satisfaction (Snyder & Lopez, 2009).

Suffering Man (detail from The Temptation of St. Anthony) by Matthias Grünewald
Suffering Man (detail from The Temptation of St. Anthony) by Matthias Grünewald

Overall I found Waddell’s attempt to describe life development exclusively in terms of orthodox object relations theory, frustratingly arbitrary and singular. Although Waddell’s integration of the work of Winnecott and Bion expands into fascinating examinations of the difference between rote and transformative learning, and of the hermeneutic role of containment, her range of influences is shockingly limited. By failing to tie her psychoanalytic developmental account to the past half century of research into child and adult development, she has produced a quixotic work that seeks to mimic literature without the necessary substance, and psychology without the necessary rigor. The book has a meandering quality, and inadequately evidenced assertions abound. For example Waddell considers how a child’s mode of identification influences their learning style (Waddell, 2002, pp105), but does not examine how primary sensory modality, or neurological competency for praxis or symbolic processing influence learning or developmental schedules.

Nor does she engage with how the contemporary global system of schooling privileges instrumental mastery over transformative understanding (Meighan, 1992). Similarly, by conflating a cultural norm (morally superior belief system) with a psychological process, Waddell makes the mistake of projecting individual psychological process in cultural and group dynamics – inferring that group function is dictated by commonalities in underlying learning style (Waddell, 2002, pp118), in a way that denies our universal capacity to rapidly devolve into pathological group dysfunction (Zimbardo, 2006). This repeats in the books frequent failure to address the role of contemporary social norms in provoking dysphoria, through their conflict with innate biological drives. For example in the ‘unrealistic fantasies’ (Waddell, 2002, pp155) of an adolescent girl to give birth at an age, and in an alloparenting context that would have been normative in the environmental of evolutionary adaptiveness (Briga et al, 2012).

Waddell situates infant emotional dysfunction squarely in the inadequacy of the ‘leaky’ or ‘convex’ container, in doing so she partakes in tradition within psychoanalysis of labelling parenting as the cause of individual and even social dysfunctions – for example the ‘schizophrenogenic mother’ (Hartwell, 1996). This view seems to privilege familial over social factors and potentially diminishes the role of genetic predisposition, social and cultural stressors and of organic damage as risk factors for dysfunction.

For me, Waddell’s examination of adolescence is the weakest section of the book. Waddell links projective processes to self exploration / experimentation (Waddell, 2002, pp147). However this self-in-other identification seems the reverse of the process underlying the adolescent construction of identity. Such processes are better explained through modelling / social learning theories (Bandura, 1976); as adolescents self consciously adopt traits and behaviours associated with social and sexual success or the possession of desirable knowledge, abilities and meaning.

Waddell is at her best when describing her work with clients whose ‘second skin functioning’ (Bick, 1986) distress approaches psychosis. By scaffolding a meaning making process for these clients, she provides a structure for the establishment of a coherent self and healthy relation to the social world. This is an optimistic and worthy approach to the treatment of severe attachment disorder, absent the robotic conditioning of CBT, or the avoidant pharmacology of psychiatry. By contrast, her literary criticism and jousting with intellectual clients, sometimes leave the reader with the impression that a good novel, or dose of person centred therapy, might be more effective than the most astute analysis.

References

Bandura, A. (1976). Social Learning Theory. USA: Pearson.

Berne, E. (1996). Games People Play: The Psychology Of Human Relationships. USA: Ballantine Books.

Bick, E. (1986). Further Considerations on the Function of the Skin in Early Object Relations. Findings from Infant Observation Integrated into Child and Adult Analysis. British Journal of Psychotherapy. Vol 2(4).

Bion, W.R. (1998). Experiences in Groups: and Other Papers. UK: Routledge.

Bowen, M. (1993). Family Therapy in Clinical Practice. USA: Jason Aronson.

Briga, M., Pen, I., Wright, J. (2012). Care for Kin: Within-Group Relatedness and Allomaternal Care Are Positively Correlated and Conserved Throughout The Mammalian Phylogeny. Biology Letters. Vol 8(4), pp 533-536.

Buss, D. (2011). Evolutionary Psychology: The New Science Of Mind. USA: Pearson

Casement, P. (1995). On Learning From the Patient. UK: Routledge.

Cioffi, F. (1998). Freud and the Question of Pseudoscience. USA: Open Court Publishing.

Hesse, E. (2008). The Adult Attachment Interview: Protocol, method of analysis, and empirical studies. In J. Cassidy, P.R. Shaver, (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed.). pp. 552-598. New York: Guilford Press.

Groff, S., (1979). Realms of the Human Unconscious: Observations from LSD Research. USA: Condor.

Hartwell, C.E. (1996). The Schizophrenogenic Mother Concept in American Psychiatry. Psychiatry: Interpersonal and Biological Processes. Vol 59(3), pp 274-297.

Meighan, R. (1992). John Holt: Personalised Education & the Reconstruction of Schooling. UK: Educational Heretics Press.

Newschaffer, C.J., Fallin, D., Lee, N.L. (2002). Heritable and Nonheritable Risk Factors for Autism Spectrum Disorders. Epidemiological Reviews. Vol 24(2), pp 137-153.

Simon, H. (1957). A Behavioral Model of Rational Choice. In H. Simon (Ed.), Models of Man, Social and Rational: Mathematical Essays on Rational Human Behavior in a Social Setting. New York: Wiley.

Snyder, C.R., Lopez, S.J. (2009). Oxford Handbook of Positive Psychology. UK: Oxford University Press.

Waddell, M. (2002). Inside Lives. Psychoanalysis and the growth of the personality. Karnac: London.

Winnicott, D. W. (2005). Playing and Reality. UK: Routledge Classics.
van Ijzendoorn, M.H (1997). Intergenerational transmission of attachment: A move to the contextual level. In L. Atkinson, Leslie, K.J Zucker, (Eds.), Attachment and psychopathology (pp. 135-170). USA: Guilford Press.

Vygotsky, L. (1978). Mind In Society. Cambridge: Harvard University Press.

Zimbardo, P. (2008). The Lucifer Effect: Understanding How Good People Turn Evil. New York: Random House.

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