Winnicott, the Play Space, and Cultural Myopia

Donald Winnicott
Donald Winnicott

Donald Winnicott made important contributions to the field of psychoanalysis which included the idea of play–especially the play between mother and child, which could be replicated by the interchange between psychoanalyst and patient.

The problem is that mother-child play outside of well-off, Western cultures is fairly rare. In most cultures, babies play alone or with other children. Their mothers are there to comfort them when they are distressed,  feed them, keep them clean and attend to their toileting needs, but there is usually not much play.

I am not an anthropologist, but I do watch families as they interact with one another whether I am on the subway or in the grocery store. I like to see how people treat one another, what norms are, what’s expected. It’s just my thing.

And I have yet to see the adults in a family living in a slum area play with their children, although I’ve witnessed plenty of mothers and children interact in slums.

That observation matches what we read in the literature. 

“…[R}esearch shows that the en face position where the mother holds the infant facing her—de rigueur for peeka-boo—is common in Westernized societies but rare elsewhere, as is the tendency of the mother to talk with the infant.” (Field et al. 1981; Ratner and Pye 1984).

Play is universal, but mother-infant play is not

Face-to-face interaction between mothers and infants outside Western cultures is rare.
Face-to-face interaction between mothers and infants outside Western cultures is rare.

Instead, play between mothers and children seems to be most common in cultures where language acquisition is of primary importance. It does not seem to have a universally important psychological function, and cultures seem to do just fine without it. But you do not develop strong language skills without it.

When I observe families from high-poverty communities–and poverty is closely related to literacy levels–I never see mothers play with their children, even when there is nothing else for the mother to do. I rarely see those mothers hold conversations with their older children. The children play with one another. The baby entertains herself. And the mother, well, perhaps she’s just resting after a long day. But she’s usually looking out the window, talking to a friend, or doing something on her phone.

Interaction between mothers and children from these communities looks like this, “Get down from there! Sit still! Put that down! Don’t touch that! Don’t hit your brother!” Interspersed with long periods of silence.

That is in sharp contrast with the conversations I see between parents and children who are clearly better off, “What was your favorite thing at the museum today? What should we have for lunch? Look at that!”

Can you guess which children start school more prepared to read? Can you predict which children will have a greater command of complex grammar or more expansive vocabularies?

Not hard, is it?

The purpose of mother-child play is language acquisition. It does not meet a universal psychological need. Psychotherapy focused on play will perhaps expand our vocabularies and advance our grammars. It’s unclear how else it might help.

So how did we end up with a major writer in psychoanalysis convinced that play between analyst and patient can prompt psychological growth? Because people who live at the top tier of the economy assume that their world is everyone’s world, or at least that it should be. Those mothers who don’t play with their children either don’t exist or are inadequate mothers. Because privilege means you don’t have to understand anyone else.

Further reading:

Lancy, D. (2007, June). Accounting for Variability in Mother-Child Play. American Anthropologist. Retrieved from: http://www.psychologytoday.com/files/attachments/48555/mother-child-play.pdf

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We Have Found Dr. Livingstone, But We Don’t Know What to Do

Photo credit: Laurent/Meeus/BSIP/Science Source. Photo Researchers, Inc
Photo credit: Laurent/Meeus/BSIP/Science Source. Photo Researchers, Inc

As helpful and life-saving as contemporary psychology and psychodynamic therapy have been to me, I have a few complaints against them. At times certain common attitudes and practices have actively disrupted and delayed my healing. And I don’t mean the occasional bumbling or even toxic therapist.  I mean what seem to be wide-spread assumptions and tendencies within the field.

To contrast, let me start by explaining what my relationship with other medical professionals looks like. When I go to the doctor or even take my cat to the vet, I am told clearly and plainly what the possible diagnoses might be, what other tests are available that could clarify the situation, what the risks and benefits of various treatment options are, and I’m left in the end to choose for myself what medical treatment plan to pursue.

If my doctor feels herself to be out of her depth, she provides a referral to a specialist. I am also free to check with other doctors for their opinions on the matter.

In other words, the process is transparent and places me in the role as a patient as responsible for my own health-care decisions. The basic assumption about the two of us–the doctor and the patient–is that the doctor is an expert in diagnosis and treatment options, while I am an expert in knowing what risks I am willing to tolerate and how much time and money I want to sink into fixing the problem. Our expertise is complementary.

It didn’t used to be like that. It used to be that you went to the doctor, and they told you what to do, and you did it more or less without question. We have changed as a society, and placing all responsibility on the doctor to know and decide what is best for the patient is no longer acceptable or practicable.

Psychotherapy, on the other, is in many ways the opposite. A clear diagnosis is rarely provided unless your condition involves a clear biological component–like bipolar disorder or depression. A treatment plan is not laid out, nor are the possible benefits or risks discussed. The patient is not free to seek out a second opinion.

In some respects, psychology remains mired in what I can only describe as colonial attitudes, in which the patient is expected to trust the good doctor implicitly to heal her.

To some extent, psychotherapy is just less clear-cut than medical science and sometimes a proper diagnosis is not known at the outset, nor exactly what treatment plan needs to be followed, but I don’t think that’s the only explanation for it. I blame the lingering influence of Freud–who had very patronizing, authority-centered attitudes toward his work.

“I am actually not at all a man of science, not an observer, not an experimenter, not a thinker. I am by temperament nothing but a conquistador–an adventurer, if you want it translated–with all the curiosity, daring, and tenacity characteristic of a man of this sort.” (Sigmund Freud, letter to Wilhelm Fliess, Feb. 1, 1900).

Although clients enter the psychotherapist’s office because they want to get better, they are expected to resist treatment. If we seek a second opinion, it is seen not as being a responsible patient, but as lack of trust for authority. Therapists still assume they need to break through our defenses.  Psychotherapy, to some extent, pathologizes the normal adult desire to be independent, autonomous, and responsible for one’s own life and actions.

My medical doctor knows that if I come in because my symptoms are bothering me, I will most likely choose an effective treatment plan and stick to it, because I want change. Most therapists assume that, despite the trouble my symptoms are giving, I will reject a diagnosis and not stick to a treatment regimen.  So the question of diagnosis is sidestepped, and the treatment plan is never overtly articulated.

This is nonsense. There are some patients who really do want a quick fix, and will quit therapy if they know how difficult it’s likely to be. But why not just tell them? A client who does not want to suffer through treatment should be free do that, in the same way that I chose not to pursue treatment of my geriatric cat’s fast-growing cancer a few months back. Why try to sneak in guerrilla therapy a client does not want and is only submitting to due to a lack of awareness?

Worse, if I really do want change, and am willing to tolerate the risks associated with it, why allow me to struggle with disappointment and frustration because I did not know how great they would be? Especially if I would embrace them if I knew they were coming?

I can tell you if I had known the degree of dissociation and trauma I needed to deal with from the outset of my 15 year search for healing, I would have articulated disbelief and resistance to it. But a core part of me would have been vastly relieved to know what the real problem was and would have been able to embark in a productive line of psychological work much earlier in the process, instead of spinning my wheels for 10 years wondering what the real problem was. If I had known what I was doing  and why, I would have been able to do it better much earlier.

In fact, it was really only when I changed my own attitude towards healing that I began to see real change: it was only after I saw myself as solely responsible for developing my own course of treatment that I began to see significant gains. When I relied on a process that was not only inadequate and ineffective, but also kept me dependent and out of control of my own psychological work, my progress was very slight. Not only was I less able to do the work, but I was less invested in it. I did not know what it was, so I could not do it as well. I did not know the purpose of it, so I was less willing to spend time or energy on it. And it was in many respects the wrong course of treatment, but I did not know to keep looking until I found the right one.

In schools, we have also shifted our attitudes about our students. Although state and national standards dictate curriculum, we talk more and more about ownership, about letting students know clearly where they are, and giving them choices about what steps to take next to improve their learning. And they are children.

So why does psychology remain so untrusting, so patronizing, and so colonial in its attitude toward patients? Why does it remain mired in the era of Dr. Livingstone, when conquered peoples were seen as savages in need of re-educating and civilizing at the hands of all-knowing authority figures? Why has it been unable to move forward in terms of how responsibility for decision-making should be distributed?