Residential treatment of frozen children
This 1958 paper was built up from a short communication read in 1956 to the British Association of Scientists. I remember my horror and amusement when I found comments on the ‘frozen children’ in a daily newspaper, which described them as ‘leading a Jekyll and Hyde existence’.
In fact, the realisation in this paper proved of very great importance, since the dawning understanding of one category of unintegrated children helped us to recognise others. It was at this point that I met the Winnicotts: I had a discussion with both of them about ‘frozen’ children, when they confirmed and clarified much that I was as yet only seeing ‘though a glass darkly’.
This paper was also published in the British Journal of Delinquency. I think my main object – in the first place, at all events – was to insist that people should realise what it was like to live and work with such children.
Barbara Dockar-Drysdale
What follows is based on my findings over the years at the Mulberry Bush School. Various factors have emerged in the attempt to evolve treatment techniques in a residential setting, to help what I would like to call ‘frozen’ children towards emotional development. These factors have caused me to relate these phenomena to a specific type of disaster experienced at the very beginning of extra-uterine life. Treatment based on my conclusions has been sufficiently successful for it to seem worthwhile discussing its implications.
THEORETICAL APPROACHES
Freud (1926) speaks of the baby’s earliest existence in the following terms:
For just as the mother originally satisfied all the needs of the foetus through her own body, so now, after its birth, she continues to do so, through other means. There is much more continuity between intra-uterine life and earliest infancy than the impressive caesura of the act of birth allows us to believe.
We believe perhaps too easily that a baby is born because it is no longer in utero; no doubt some babies are, as it were, more ‘born’ than others: but the baby seems to have a second ‘intra-uterine’ life, the length of which will depend on the nature of the particular unity established as a mother-child entity. Barbara Low uses the term ‘nirvana principle’, which was accepted by Freud and which sprang from Fechner’s concept of a tendency to return to the inorganic. Freud suggests (1926) that the ‘nirvana principle’ is therefore enlisted in the service of the ‘death instinct’. In 1922 Freud wrote: ‘The tension then aroused in the previously inanimate matter strove to attain an equilibrium; the first instinct was present, and that to return to lifelessness.’ I wish to substitute for ‘lifelessness’ the word ‘selflessness’. I suggest that if a tendency to stability is not regarded as a trend towards a return to the inorganic (lifelessness) but toward selflessness, the whole concept becomes quite acceptable. There is in this case no further need to visualise the child striving to return to the womb; his goal being, in fact, nothing more distant than his mother’s arms. I would like to describe this very early period of emotional development as a tactile phase, really pre-oral.
We believe that in the temporary absence of the mother the baby hallucinates her presence, and it seems unlikely that, unless disaster befalls, the baby feels in any way separate from its mother; this would only arise if the baby had to hallucinate for longer than the hallucination could be held (rather like the fading out of hypnagogic imagery). Providing that the concept of the unity can be accepted, we must then consider the transition from the tactile to the oral phase. I suppose that the unity exists during the first weeks of life, and that in normal development there is a gradual withdrawal from it which is so slow and gradual as to pass unnoticed; but made by the child with support form the mother, until the emergence of ‘me-ness’ (Hartmann, 1954 and others). In the case of normal development, is seems unlikely that either mother, baby, or external observer need ever be aware of a state where the baby is neither part of the mother nor a separate entity establishing a dependent object relationship towards her. The whole problem is tackled so gradually that there need never be what a ‘frozen’ child in the process of recovery once described to me as ‘a great gulf’.
Freud has given detailed descriptions of what he calls ‘primary narcissism’. He has, however (as far as I know), only made a couple of references to the concept of ‘primary masochism’. For example, he writes (1922): ‘The exposition I then gave of masochism needs correction in one respect as being too exclusive; masochism may also be what I was there concerned to deny, primary.’ And elsewhere (1926) he writes:
After the chief part of it [the death instinct] has been directed outwards towards objects, there remains as a residuum within the organism the true erotogenic masochism, which on the one hand becomes a component of the libido and on the other still has the subject itself for an object. So that this masochism would be a witness and a survival of that phase of development in which the amalgamation, so important for life afterwards, of death instinct and Eros took place……It then provides that secondary masochism which supplements the original one.
Freud links primary masochism with the death instinct, and I am sure that this is absolutely correct, although as he points out, in the course of development primary masochism is not easily to be observed (in contrast to narcissism). I suggest that during the unity the mother’s narcissism includes the baby and is so great that it far outweighs any self-destructive tendency; which in any case would not be significantly present in the normal mother (having been dealt with long ago); the baby, as we know, would revive the mother’s earliest narcissism, causing her to over-estimate her child. The baby’s reservoir of primary narcissism is therefore constantly replenished by its mother from her own store, and the existence of the other reservoir – that is to say, primary masochism – need never become apparent because the narcissistic reservoir does not, as it were, drop its level sufficiently for such an inflow, because of the functioning of the unity.
It is important to stress that the mother’s share of the unity is a much more sophisticated version; it is not usually a matter of life and death as it is for the baby who has no other life but that which he shares with her. The withdrawal of either the mother or the baby is felt as an actual loss of self by the other during the period of unity. We know a considerable amount about the mother’s experience of unity. She also is merged; she lives for her child – that is to say, for herself. We know how much her baby seems a part of her; we know how tragically she may react to even his temporary loss as a loss of herself, part of her entity. By the time the unity is finally dissolved and the early object relationship is established, the self-destructive primary masochism of the baby will be projected on to the mother and the outside world; in other words, aggression against self is projected outwards. Some of this aggression will be experienced as direct aggression, some will return against the self as secondary masochism.
I believe that in the so-called ‘affectionless’ child, whom I prefer to describe as ‘frozen’ (‘affectionless’ sounds final, but a thaw can follow a frost), we see the tragic outcome of a disrupted unity, where the baby has been separated from its mother for any one of many causes. We know that in such a case disaster is not inevitable; that another person able to form part of a unity can re-establish this with the baby before it is too late, or better still (as in the case of hospitalisation, for example) the mother may be able to re-establish it herself. The disruption of the unity may arise from reality external causes, or it may spring from the personality difficulties of the mother herself, who may be unable to sustain the unity. Our sources of information concerning the other part of a disrupted unity – the baby – must be tapped of necessity in retrospect in the behaviour patterns which are the devices for survival used by the doomed baby, and still used with practically no modification or development by the seven-year-old ‘frozen’ child.
Every baby, left by himself, will find pleasure and comfort in his own body. I assume that he discovers pain himself at about the same time or a little later (the finger in his eye, the scratched cheek, and the pulled hair, for example). In normal circumstances, since his mother is part of himself, there is little difference between pleasure in himself or in her. Pain, also, he must associate with her as part of himself, so that he hurts himself, he hurts the whole unity. However, the balance, as we have already said is sharply tilted in favour of the pleasure side of the scales. The pain the mother is most likely to cause is negative, in the form of absence; should this be prolonged beyond the scope of self-comfort available to the baby he attacks himself and his immediate environment as the only part of the unity still available. Should her absence continue he is thrown back for all pleasure-pain experience on his limited part of the unity. The resulting situation is one in which self-pleasure and self-pain are more evenly balanced; the desperate dread of self-destruction and frantic hope of self-preservation being the deciding factors in the subsequent history of such a child.
The baby within the safety of the mother-baby unity of the first months of extra-uterine life can, I believe, in the normal course of development experience sorrow, pain, rage and fear; the unity can support these experiences. However, there may be no need for the baby to take the appalling impact of despair, agony, frenzy and panic. The first group of experiences I would like to call ‘inner circle’, the second group, ‘outer circle’. I do not believe that in normal circumstances the ‘outer circle’ group can break through the unity of mother-child which acts as Freud’s ‘barrier against stimuli’. There are, of course, comparable groups in the pleasure side; for example, contentment is ‘inner circle’, ecstasy is ‘outer circle’. Should there, however, be circumstances of either an external reality or an internal psychic nature to disrupt the unity, then the ‘outer circle’ can and does break through, and the impact must be sustained. This is what I mean when I speak of a broken unity. Should such a baby develop into a ‘frozen’ child, I have found that he is unable to be afraid – he panics; he is unable to be sad – he is in despair. I have been with children who are consciously feeling sad or afraid for the first time in their lives, and who need much reassurance in what is to them a new experience. The ‘outer circle’ experiences have, till their recovery, been of infinite duration while experienced.
A baby who is prematurely self-reliant for all emotional experience does not lose the urge to merge back into the original unity. He does not therefore become a personality within boundaries, as a normal child will do; who comes in the course of maturation gradually to love the mother as a person separate from himself. The child whom we are considering does not make relationships, he does something very much more primitive; he extends and withdraws himself so as to include people whom he uses to provide him with pleasure. He also uses them to ward off pain, by inflicting pain on them, as part of himself, rather than on his very self. Should the person whom he has thus enclosed fail to provide pleasure, he will immediately withdraw; as in the old nursery rhyme, he cries ‘This is none of I’. Withdrawals are often mistakenly regarded as breakdowns of relationships, but there has never been a relationship, in the ordinary sense. The behaviour of such children is often described as regressive, when in fact there has been no advance from which to regress.
CLINICAL OBSERVATIONS
A typical ‘frozen’ child in a therapeutic institution presents a curiously contradictory picture. He has charm – that kind of charm which causes people to say ‘I don’t know what it is about him……’ He is apparently extremely friendly, and seems to make good contacts very quickly. He is neither shy nor anxious in an interview, and in his everyday existence he is usually healthy, clean, tidy and orderly. He is frequently generous and kind to younger children, especially one particular child whom he protects against all attacks. In astonishing contrast he may become suddenly savagely hostile, especially towards a grown-up with whom he has been friendly. He will fly into sudden panic rages for no apparent reason, in which he smashes and destroys anything in his vicinity (I have known it to be necessary for three adults to control a ‘frozen’ child in one of these states of frenzy). He is a disturbing element in class – a storm centre – and frequently has acute learning difficulties. Sometimes he seems to build a high wall between himself and other people which is impossible to scale or break through. He steals, lies and destroys relentlessly and without the slightest indication of remorse. It is common to hear workers remark: ‘It’s impossible to believe it is the same child.’ He may manage during one of these periods to continue to show kindness and protection to a particular younger child, but equally he may be cruel to him (in this connection, he is always either cruel or wildly over-indulgent to animals which appear afraid of him). It is repeatedly reported that he is improving and hopes are raised; it is claimed that he is making a relationship at last, but each time disaster follows, until finally he becomes intolerable to his environment. The longer the period of supposed improvement, the more drastic is the breakdown; experience teaches one to think in terms of lull and storm, rather than maturation and regression or recovery and deterioration.
There is another side to the picture which is equally disquieting. The ‘frozen’ child is, of necessity, delinquent; he may easily become a ‘delinquent hero’ who gives permission to the other members of the group to break in, steal or destroy. His own lack of remorse, the fact that he can do these things without emotional discomfort, has the most disastrous effect upon all but the most integrated group. In general, the fact that he usually has a current façade relationship has a disrupting influence on an unwary treatment team. (It is very trying to hear the constant comment ‘But he is never like this with me’ – which in fact only means that his negligible frustration threshold has not yet been reached, the first ‘No’ has yet to be said!) There often seems to be a conspiracy between child and adult in which the adult is as willing as the child to be unaware of the doppelganger – this monster which suddenly appears instead of the charming child, and which vanishes as suddenly.
This is the picture they present – at seven years, or twelve or sixteen years; there need be no change of pattern, although at seven years the techniques for living this way of life are more apparent than they are at sixteen years, because they are less skilled. Evidence must be looked for in acting out within the environment. There is very seldom any internalised fantasy material available.
Observing this kind of child’s behaviour one asks oneself how he can contrive to be utterly without remorse or scruples: how can he live in this state of high tension? We know that he cannot risk being left short of satisfaction for an instant, because the moment that the level of his pleasure drops, pain will flow in. Having withdrawn from frustration he must therefore use any means in his power to maintain the pleasure level, since postponement of satisfaction cannot be risked. It follows naturally that such means will inevitably tend to be delinquent. If, however, the larder door should be locked, grown-ups’ pockets empty, or windows securely latched, then crisis will follow, and the second type of merger will take place; in the effort to keep himself form self-destruction he will attempt to destroy his environment, which is felt to be an extension of himself.
Supposing that, as is usually the case, delinquent means are available, how (moral scruples apart) does he ignore inevitable consequences? – There are bound to be disciplinary measures, disapproval and exclusion from the group. The ‘frozen”’ child leads a highly organised and disciplined life but the organisation and the discipline are pathological. There are certain modifications which he has made, and it is precisely these which made it possible for him to maintain some sort of equilibrium.
In the first place, he has achieved what Fritz Redl (1951) terms ‘reality blindness’. He does not merely deny that he has done some delinquent or aggressive act, he does not himself know that he has done it. He cannot afford to be aware of any steps he takes to obtain satisfaction; for him there is no gap between instinctual need and the satisfaction of that need. Perhaps it would be more correct to describe this in a more active way as ‘selective perception’ rather than ‘reality blindness’. One recovering child told me: ‘I could look at a speck on the wall and not see anything else in the room, and I could always do this with everything.’
Secondly, he has no concept of time. There can be no past to regret, and no future to consider; he lives in the present. He has another safety valve which I have come to think of as ‘the reality annexe’. This is represented by an adult, usually on the fringe of the child’s environment, whom he uses in a very special way. He uses all his charm on this person, but makes no demands and carries out no reality testing. Frustration never has to be tolerated, because he asks for nothing; instead he satisfies his wishes by delinquent means within his environment, leaving the figure in the reality annex in tact. This provides him with a person who can remain perfect, so that when he is forced to withdraw from one of his extensions by the threat of frustration, he has this almost unreal figure – who is not in the immediate situation – to serve him until he can arrange the next extension. Peter, with a reality annex B, stole money from us and with it bought presents which he described to us as having been given to him by B. When I showed him what he was doing he broke down in panic, then he was finally reassured and able to tell me that he now realised that he had constantly done this; he gave many examples and explained: ‘I can’t ask, for fear they say “no”, so I don’t ask, I just get the things and then they have given them to me.’
The child whom he takes under his wing is an extension of himself; his indulgent attitude is in fact self-indulgence, just as his cruel and punitive treatment of the same child is equally extended-self directed. (We can see here how close the role of protégé lies to that of scapegoat.) His role as delinquent hero secures him material for storm raising, which he does when he is intent on keeping his violence away from himself; on such occasions he is capable of reducing a reasonable group of children to a howling destructive mob. These are all attempts to achieve synthetic unities; he is totally unaware that he uses these techniques – how can he be described as responsible for them?
During the years we have tried to help many of these children. At first we admitted ‘frozen’ personalities into our group of forty behaviour problems without realising the implications. We mistook these children for neurotic delinquents, and they caused a great deal of havoc and unrest among staff and children until we gradually became aware of the nature of the problem. We are frequently puzzled as to why certain children are not ‘frozen’. I know of several cases where, though there was apparently no mother substitute, a little child has been able to become part of a true unity of infinite depth although only of brief duration, which we were actually able through fortunate circumstances to restore. Unfortunately, however, these brief though deep experiences have been interrupted, so that they tend to be a repetition of the original trauma. It is interesting in this connection that Freud expresses his understanding of trauma as being a state of helplessness.
We have slowly evolved techniques for the treatment of ‘frozen’ children which appear to be successful: we have seen actual changes in their personalities resulting from a particular approach. Indications of conflict have appeared leading to dependence on us, with evidence of deep depression and anxiety (real signs of emotional recovery, since it has long been realised that a delinquent character can only become normal through the experience of neurosis).
There seem to be two stages of the depressed period. The first is general, and applies to every sphere of the child’s existence. He will often become ill, he will be apathetic in every situation and will sit with tears running down his cheeks. He tends to retire to bed; he sits quietly in class, but with no sign of intellectual interest; he altogether presents a tragic picture: this is what we call an ‘unfocused depression’. The second part of the depression is different, it is focused on the person with whom the child is now making a primary bond. When this second stage of depression has been reached it is not any longer apparent in every field; the child begins to make educational progress and becomes quite worried and anxious in various aspects of his life. There is, however, the deepest possible attachment to the gown-up of his choice, and in the absence of this person for any length of time the most desperate anxiety is expressed. Disapproval from the special grown-up has become intolerable, and there is evidence of a reaching out towards dependence. Providing that this second stage can be reached, there is little likelihood of reversal, as far as we can see. The earlier stage is by no means so established and the child may revert to the previous delinquent behaviour pattern described.
The second stage of depression and the type of dependence on the grown-up concerned appear to me to have a different significance from that of a transference situation in the usual sense. I suggest that precisely because this is a primary experience there is in fact no transference involved, since there is nothing to transfer. We have, however, had occasion to notice that several of these children who have left us (either to go home, or to another school, or to children’s homes) appear to make a transference to a parent figure in the new situation.
With regard to the first stage of depression, I am quite certain that this is a ‘state of mourning’ for the loss of the unity; the realisation that this is something which cannot be regained. It was at this point that a little girl said to me: ‘I feel that there is a great gulf which I cannot cross, so now I must go on.’ This would represent an experience never really known in normal development, where a baby has ceased to be part of the mother without yet having formed an object relationship with her. The second stage of the depression represents, I think, the establishment of this object relationship. However, it is absolutely essential that the ‘frozen’ child shall go through the first part of the depression, because at some point or other during this he faces the fact that he has lost the unity for ever, that this cannot be regained. During the later part of treatment (the second stage of depression) when such a child has become an anxious, sad little creature, deeply dependent and infantile, one sees him now and then attempting to use the old mechanisms which now of course no longer function because he has ceased to be ‘reality blind’.
An interesting point is that it is remarkable how ‘frozen’ children who are making a recovery remember most vividly the primary experience through which they have just passed, and they themselves speak of the nature of the mourning and loneliness experienced in the first depression. One child said to me: ‘I knew then that I had really been born.’ These memories seem to remain extremely vivid, so that several years later children have referred to them, when they have come back to see us. There does not seem to be any amnesia involved, and the memory seems to remain conscious and with very little distortion.
Treatment for this special group is on educational therapeutic lines. At no point is one justified in being merely permissive with a ‘frozen’ child; one must be controlling, disapproving but not rejecting, approving but not seduced into serving as an extension of the child. At first the behaviour pattern is most carefully observed and reported, until constant repetition of the pattern has made it familiar to the therapist. Next, interruption is introduced; this involves breaking into a behaviour pattern at a critical point in order to make the child aware of what he has done, is doing, and plans to do. A next stage is reached when the first signs of a pattern can be recognised. Each child has a sort of signature tune, which becomes familiar. Interruption now takes place at so early a stage that I think we are justified in speaking of anticipation.
James was filthy – he had, I knew, been completely changed just an hour before. However, this was his ‘signature tune’: he always became dirty before a burst of delinquency. I said quite simply: ‘James, go and get clean, you don’t have to break in and pinch.’ (We knew each other rather well by this time.) He departed to matron and reappeared presently clean and tidy. ‘All right’, he said, ‘have you got a job for me instead?’
Michael played his particular signature tune – a dysrhythmic tapping. I collected him, and pointed out that there was a storm brewing. ‘How do you know?’ he demanded. I explained, referring to previous occasions, ‘You know, I’ve never noticed,’ said Michael. We agreed that he would notice from now on; that the tapping would be a danger signal for him as well. Then we discussed the whole situation, and took measures to avert the storm.
I said to Philip, ‘I won’t let you hurt George’. I held him and be bit himself -very hard. ‘Now see what you’ve made me do,’ he screamed. I had not been quick enough on this occasion; I had prevented him hurting George but had not anticipated the inevitable attack on himself.
When interruption or anticipation is used correctly, acute disturbance is felt by the child, and he needs a great deal of support and reassurance. He will do everything in his power to close the gap which has been made in his defences. His response to early interruption is panic and rage, often with actual suicidal threats. If, however, the gap can be kept open by steady interruption and anticipation used in the context of his everyday life, then the next stage may be reached; he returns as it were to the chaos beyond which he has had to isolate himself. Here we meet the first unfocused depression, to which I have made reference, which affects every field of the child’s life; during it he re-experiences the loss of the unity and faces the fact that this cannot be restored.
It is at this stage that a kind of bond can be achieved with the therapist; the child becoming utterly babylike, dependent and trusting, completely vulnerable and helpless. It is from this point – and I would assume only from this point – that he can slowly become loving and loved as a complete person (this is the second stage of the depression where it becomes focused on the therapist). One such recovering child said to me one night: ‘This bed has an edge like me, but I can put out my hand and hold yours!’ This same little boy called kisses ‘edges’. ‘Give us an “edge”’, he would demand, ‘I like “edges”. They show where I stop and you start.’
I should like to add one example of a particular aspect of the problem which I have described, namely, unawareness of inconvenient reality, and of the measures taken to change this perilous technique for living which is employed of necessity by ‘frozen’ children.
John (who was nine years old, of average intelligence) had a history of early separation from his mother: there was now the usual picture of a child unable to make relationships, with a severely delinquent behaviour pattern aided by reality blindness, and a highly developed speed of movement (a sort of sleight of person!).
One night, just as he was leaving the bathroom, he threw a clean towel into the bath – which was full. The worker in the bathroom at that time had, by chance, seen this, and called him back to retrieve the towel. John of course did not pay any attention and proceeded singing on his way, after a casual shout of ‘No, I didn’t’. By now he knew nothing about the towel in the bath. It so happened that I was at the top of the stairs so, taking his hand I said: ‘Come on, John, we’ll go back together and you can take the towel out of the bath – it’s quite safe to know you’ve done it.’ John, usually very cool and tough, became pale, trembled and screamed terrified obscenities at me. I carried him back to the bathroom kicking and shrieking. I assured him again that he really had put the towel in the bath. He continued to scream, and screwed up his eyes. I stayed with him, holding him solidly, re-affirming the facts, and reassuring him; till at last, dreadfully afraid and trembling, he took the towel out of the water. Even now he turned his face away so as to avoid seeing what he was doing, then quite suddenly he gave a great shuddering sigh, wrung out the towel and hung it on the side of the bath. After which he turned to me with a transfigured and radiant face and ran into my arms. I carried him upstairs, tucked him up in bed and he sank almost at once into a deep sleep, still holding my hand.
On another occasion John, who had failed to break into the larder, threw a stone at another child, and flitted round the corner of the house. Having comforted the victim of the attack I picked up the stone and followed John. I held out the stone to him saying, ‘This is the stone you threw at Peter.’ He stood stock still, staring at the stone, then with great hesitation took it from me and turned it over gingerly in his hand. Finally he said, ‘I’m able to hold it, aren’t I?’
A child came in sobbing. While I was soothing him, John appeared at the window. ‘It was me what done it,’ he said, ‘an accident. I’m sorry’. He spoke very quietly and softly, as though afraid to overehear himself.
This child, in becoming instantly unaware of having thrown the towel into the bath, was using the reality blindness which had become so much part of him that he unconsciously employed this defence in every aspect of his life. The therapist, by bringing the defence to a conscious level, made a gap, which produced panic which the therapist then relieved by offering steady support and help to face reality. Constant and consistent repetition of such interruption, and protection, brought John to a point at which he could hold the stone without panic. Finally, we see him at a stage at which he can allow himself to be aware of his motions, although he now rationalises (he said it was an accident). In the meantime, he has changed from a bright hard young tough – a ‘wild one’ in the making – to an anxious little boy; stormy, difficult, but deeply attached to a teacher, whose approval he values and whose disapproval causes him pain.
In conclusion, it is my opinion that the psychopath leads a continuation of the desperate existence precariously maintained by the ‘frozen’ child.