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Boundary and Space: An Introduction to the Work of D. W. Winnicott
BOOK REVIEWS Starving to Death in a Sea of Objects: The Anorexia Nervosa Syndrome. By John A. Sours. New York: Jason Aronson. 1980,448 pp., $30.00. Reviewed by Richard Galdston, M.D. * Anorexia nervosa is a syndrome of metabolic madness a paradigm for psychosomatic disease. Typically, it appears in an adolescent girl seized with an intensely felt need to diminish her bodily dimensions through cutting down food intake and by exercising. Patients with anorexia nervosa can maintain a balance between anabolic and catabolic efforts that results in a clinical picture that is confusing. John Sours, M.D., has written a masterful study of the syndrome in all of its complexities. It will likely remain the authoritative treatise on the topic for some time to come. The book comprises two parts, one fiction, the other factual. Following a brief introduction epitomizing anorexia nervosa as "a caricature of will," Dr. Sours seeks to portray the pathological processes in a novel about a high school student and her family. Barbara Gordon is driven by her passionate desire for perfection as she conceives it to be embodied in thinness. Her pursuit of this ideal leads her on an "ego-trip" that takes Barbara and her parents from their upper class New York City base into a series of "jet-set" journies in search of relief. Their story is a chronicle of medical-psychiatric mismanagement. Family narcissism combines with professional ineptitude to rob the heroine of the care she requires. The family junkets from New York to London, Paris, and Switzerland, providing a sort of travelogue of "in" places, scenes, and things that money can buy. Not finding what they need, the family returns to New York City where the novel ends, in tragedy for all. Dr. Sours keeps a fast pace over the 200 pages he devotes to the story. It includes most of the phenomena met in the clinical course of anorexia nervosa and many of the vicissitudes encountered in trying to provide psychiatric care for narcissistic people whose unenlightened self-interest rob them of the chance to learn what would be good for them. There is a problem inherent in writing fiction about an illness, especially one that involves the derogation of character supplanted by monomania in the idea of perfection. The ingredients essential to a novel-adventure, excitement and conflict in the development of lives impinging upon each other-are difficult to
Reviewed by Charles Walton, M.D.t The writings of Donald Winnicott have become the object of increasing interest in recent years. This in-
• Dr. Richard Galdston, is Chief of Consultation Service Children's Hospital, Boston, Mass. '
t Dr. Walton is the Director of Clinical Services Children's Hospital at Stanford Medical Center, Palo Alto, Califo;nia.
weave into a theme dictated by the decline and fall of a girl whose adolescence fails to release her from the constraints of a demanding and empty childhood. The second half of the book is reserved for the facts about anorexia nervosa. Within a text of 175 pages Dr. Sours cites and summarizes references that require a bibliography of over 40 pages. He includes a scholarly presentation of the salient writings of authors from the 3rd century to the present. The historical review is followed by a detailed description of the anorexia nervosa syndrome. A chapter on phenomenology offers a thoughtful consideration of many of the important features that make the clinical picture. Chapters on the families and on the developmental patterns of the patients offer a thorough analysis of the forces and backgrounds from which the syndrome can emerge. The final chapter on the theory and techniques of treatment is generous and even-handed in discussing the variety of approaches to the issues of treatment. Dr. Sours writes well. His style is pliant, accommodating to the requirements of the topic at hand. He is crisp and terse in summarizing the physiology of starvation, eloquent and poetic in his clinical vignettes and judicious and restrained in his opinions about treatment. He is at ease dealing with the rumbling Latinate phrases of psychoanalytic metapsychology and polite in presenting the contentious claims of family therapists. My only wish is that Dr. Sours had written more of his own observations from his clinical experience in his own words. I have the impression that his efforts at fairness in achieving an encyclopedic study have deprived his readers of some personal knowledge about the care of patients from which there might be more to gain. His observations about the features common to the psychic substrates of patients with anorexia nervosa, professional ballet dancers and marathon runners, were of particular interest to me. I recommend this book with enthusiasm as an important contribution to current psychiatric literature. Boundary and Space: An Introduction to the Work
of D. W. Winnicott. By Madeline Davis and David Wallbridge. New York: Brunner/Mazel 1981, 224 pp., $17.50.
527
528
BOOK REVIEWS
terest has not been limited to clinicians literature and "creativity." Highly original concepts and descriptions of mother-infant relations and ego integration, early ego states and ego development, compliance, false-self development, psychotherapy, and many other topics have attracted and intrigued developmental psychologists and clinicians. Readers new to Winnicott's writings have divided themselves into two groups. There are those who have felt able to follow his writing style and understand his formulations; and those who felt baffled or put off by the somewhat unusual style, the use of new meanings for familiar words such as "holding," "annihilation," "false self," and the unique and subtle nature of some of his formulations. The book, Boundary and Space offers a new avenue to understanding. It takes up systematically the many concepts with which Winnicott was concerned. The authors present an initial introductory statement followed by a parapharse or explanation of what Winnicott wrote; the text is interspersed liberally with passages directly from Winnicott's writings. An excellent feature of this approach is that the authors have brought together quotations and statements on each topic from various writings and talks, many of which are not readily available. For many concepts the authors have done an excellent job of explaining and clarifying the meaning of difficult concepts; for example, the notion that giving up omnipotent control of an object means the destruction of the object, whose external survival then means that it exists, as an entity in its own right. In other attempts, I believe, the exposition is less successful. Frequently in my reading I wondered why the authors did not let Winnicott say it himself instead of using extended and less interesting paraphrasing and explanation. In describing the concept of "holding," for example, the description was all too brief and did not do justice to the broader notion of "the holding environment" which appears repeatedly in his writing. Winnicott's several papers and numerous references to psychoanalytic and psychotherapeutic technique with adults and children are not referred to apparently because of the intent of the authors to limit this presentation to "the main strands of his theory of personal development and to show how he contributed to an understanding of the significance of infancy in the total life of human beings." The writings on technique and psychoanalysis and education for psychotherapy, although scattered throughout Winnicott's collections of papers or referred to in passing in papers on early ego development, are fascinating and instructive and well worth tracking down, beginning with "Hate in the Countertransference," which appears in
Through Paediatrics to Psychoanalysis (Winnicott, 1958). Boundary and Space begins with a section entitled "The Background," which provides a brief interesting look at Winnicott's intellectual life and the development of his theory. Anyone who is interested in his life story in more detail should read Clare Winnicott's (1978) personal biographical remembrance appearing in Between Fantasy and Reality, a collection of papers on various applications of the concept of "transitional phenomena." How does Boundary and Space fulfill the task of providing the reader with an understanding of Winnicott's writings? For each topic clear explanations and ample quotations are given so that a read through from cover to cover provides a complete picture of his theory. However, since most headings are in Winnicott's own terms, such as, "the false self," "the potential space," and "holding," the book would be less useful for someone wishing to compare directly Winnicott's ideas with those of others on a commonly used concept, such as "psychosexual development." Finally, there is a minor complaint which should not detract from the valuable contribution this book makes to our understanding of Winnicott. Although it was not a stated purpose of the authors to compare and contrast Winnicott's ideas with those of other writers on clinical and theoretical aspects of development, personality, or psychotherapy, or to depict changes and developments in his own thinking through time, for example with regard to Melanie Klein's concepts, references such as these would be useful to help the reader fit these ideas into a broader context. Boundary and Space is highly recommended as an introduction to the writings of D. W. Winnicott, as well as for readers already familiar with some concepts and wishing to explore further. It is suggested that if possible one should read one or two of Winnicott's papers in the original (Winnicott, 1958, 1964, 1971) as an introduction to the Introduction. References WINNICOTT, C. (1978), D. W. W.: A Reflection. In: Between Fantasy
and Reality, ed. S. Grolnick & L. Barkin. New York: Jason Aronson. WINNICOTT, D. (1958), Through Paediatrics to Psychoanalysis: The Collected Papers of D. W. Winnicott. New York: Basic Books. (1964), The Child, the Family, and the Outside World. London: Penguin Books. (1971), Playing and Reality. New York: Basic Books.
Delinquency in Human Nature. By D. H. Stott. Baltimore: University Park Press. 1980,415 pp., $24.50. Juvenile Delinquents: Psychodynamic Assessment in
Reviewed by Charles Walton, M.D.t The writings of Donald Winnicott have become the object of increasing interest in recent years. This in-
• Dr. Richard Galdston, is Chief of Consultation Service Children's Hospital, Boston, Mass. '
t Dr. Walton is the Director of Clinical Services Children's Hospital at Stanford Medical Center, Palo Alto, Califo;nia.
weave into a theme dictated by the decline and fall of a girl whose adolescence fails to release her from the constraints of a demanding and empty childhood. The second half of the book is reserved for the facts about anorexia nervosa. Within a text of 175 pages Dr. Sours cites and summarizes references that require a bibliography of over 40 pages. He includes a scholarly presentation of the salient writings of authors from the 3rd century to the present. The historical review is followed by a detailed description of the anorexia nervosa syndrome. A chapter on phenomenology offers a thoughtful consideration of many of the important features that make the clinical picture. Chapters on the families and on the developmental patterns of the patients offer a thorough analysis of the forces and backgrounds from which the syndrome can emerge. The final chapter on the theory and techniques of treatment is generous and even-handed in discussing the variety of approaches to the issues of treatment. Dr. Sours writes well. His style is pliant, accommodating to the requirements of the topic at hand. He is crisp and terse in summarizing the physiology of starvation, eloquent and poetic in his clinical vignettes and judicious and restrained in his opinions about treatment. He is at ease dealing with the rumbling Latinate phrases of psychoanalytic metapsychology and polite in presenting the contentious claims of family therapists. My only wish is that Dr. Sours had written more of his own observations from his clinical experience in his own words. I have the impression that his efforts at fairness in achieving an encyclopedic study have deprived his readers of some personal knowledge about the care of patients from which there might be more to gain. His observations about the features common to the psychic substrates of patients with anorexia nervosa, professional ballet dancers and marathon runners, were of particular interest to me. I recommend this book with enthusiasm as an important contribution to current psychiatric literature. Boundary and Space: An Introduction to the Work
of D. W. Winnicott. By Madeline Davis and David Wallbridge. New York: Brunner/Mazel 1981, 224 pp., $17.50.
527
528
BOOK REVIEWS
terest has not been limited to clinicians literature and "creativity." Highly original concepts and descriptions of mother-infant relations and ego integration, early ego states and ego development, compliance, false-self development, psychotherapy, and many other topics have attracted and intrigued developmental psychologists and clinicians. Readers new to Winnicott's writings have divided themselves into two groups. There are those who have felt able to follow his writing style and understand his formulations; and those who felt baffled or put off by the somewhat unusual style, the use of new meanings for familiar words such as "holding," "annihilation," "false self," and the unique and subtle nature of some of his formulations. The book, Boundary and Space offers a new avenue to understanding. It takes up systematically the many concepts with which Winnicott was concerned. The authors present an initial introductory statement followed by a parapharse or explanation of what Winnicott wrote; the text is interspersed liberally with passages directly from Winnicott's writings. An excellent feature of this approach is that the authors have brought together quotations and statements on each topic from various writings and talks, many of which are not readily available. For many concepts the authors have done an excellent job of explaining and clarifying the meaning of difficult concepts; for example, the notion that giving up omnipotent control of an object means the destruction of the object, whose external survival then means that it exists, as an entity in its own right. In other attempts, I believe, the exposition is less successful. Frequently in my reading I wondered why the authors did not let Winnicott say it himself instead of using extended and less interesting paraphrasing and explanation. In describing the concept of "holding," for example, the description was all too brief and did not do justice to the broader notion of "the holding environment" which appears repeatedly in his writing. Winnicott's several papers and numerous references to psychoanalytic and psychotherapeutic technique with adults and children are not referred to apparently because of the intent of the authors to limit this presentation to "the main strands of his theory of personal development and to show how he contributed to an understanding of the significance of infancy in the total life of human beings." The writings on technique and psychoanalysis and education for psychotherapy, although scattered throughout Winnicott's collections of papers or referred to in passing in papers on early ego development, are fascinating and instructive and well worth tracking down, beginning with "Hate in the Countertransference," which appears in
Through Paediatrics to Psychoanalysis (Winnicott, 1958). Boundary and Space begins with a section entitled "The Background," which provides a brief interesting look at Winnicott's intellectual life and the development of his theory. Anyone who is interested in his life story in more detail should read Clare Winnicott's (1978) personal biographical remembrance appearing in Between Fantasy and Reality, a collection of papers on various applications of the concept of "transitional phenomena." How does Boundary and Space fulfill the task of providing the reader with an understanding of Winnicott's writings? For each topic clear explanations and ample quotations are given so that a read through from cover to cover provides a complete picture of his theory. However, since most headings are in Winnicott's own terms, such as, "the false self," "the potential space," and "holding," the book would be less useful for someone wishing to compare directly Winnicott's ideas with those of others on a commonly used concept, such as "psychosexual development." Finally, there is a minor complaint which should not detract from the valuable contribution this book makes to our understanding of Winnicott. Although it was not a stated purpose of the authors to compare and contrast Winnicott's ideas with those of other writers on clinical and theoretical aspects of development, personality, or psychotherapy, or to depict changes and developments in his own thinking through time, for example with regard to Melanie Klein's concepts, references such as these would be useful to help the reader fit these ideas into a broader context. Boundary and Space is highly recommended as an introduction to the writings of D. W. Winnicott, as well as for readers already familiar with some concepts and wishing to explore further. It is suggested that if possible one should read one or two of Winnicott's papers in the original (Winnicott, 1958, 1964, 1971) as an introduction to the Introduction. References WINNICOTT, C. (1978), D. W. W.: A Reflection. In: Between Fantasy
and Reality, ed. S. Grolnick & L. Barkin. New York: Jason Aronson. WINNICOTT, D. (1958), Through Paediatrics to Psychoanalysis: The Collected Papers of D. W. Winnicott. New York: Basic Books. (1964), The Child, the Family, and the Outside World. London: Penguin Books. (1971), Playing and Reality. New York: Basic Books.
Delinquency in Human Nature. By D. H. Stott. Baltimore: University Park Press. 1980,415 pp., $24.50. Juvenile Delinquents: Psychodynamic Assessment in