Tea with Winnicott

by Brett Kahr with illustrations by Alison Bechdel. Published by Karnac, 2016.

Reviewed by Dr Neil Vickers.

Brett Kahr’s Tea with Winnicott is the first volume to appear in Karnac’s new ‘Interviews With Icons’ series, in which contemporary psychoanalysts conduct imaginary interviews with major figures from the psychoanalytic pantheon. Brett Kahr, psychoanalyst, Winnicott scholar and Winnicott’s first biographer, is first up with a sequence of ten riveting interviews with Donald Woods Winnicott (1896-1971), the paediatrician turned psychoanalyst who played a vital part in the evacuation of children during the Second World War. Winnicott’s legacy is arguably the most influential of any psychoanalyst from the English-speaking world. As I write, his paper on ‘Transitional Objects and Transitional Phenomena: A Study of the First Not-Me Possession’ first published in 1953 is the most popular journal article in Psychoanalytic Electronic Publications Online, which contains a huge proportion of all psychoanalytic papers ever published (n > 45,000). Indeed four of the top 10 articles are by him. Kahr knows the Winnicott archive inside out, having enlarged it considerably through his friendship with Winnicott’s secretary, Joyce Coles, and many of the statements attributed to Winnicott in this book originate in the great man’s writings, published and unpublished.

Ernest Jones, the St. Paul of British psychoanalysis, called Winnicott the first male child psychoanalyst. Kahr observes that he was also ‘the first proper media psychologist in Great Britain’ (187). From the 1940s onwards, he made radio programmes aimed at mothers and fathers, on child development, play, and the meaning of delinquency and adolescence. Many of these programmes were produced or commissioned by Isa Benzie for the BBC, who was struck by a phrase Winnicott used casually in conversation with her, ‘the ordinary devoted mother’ (she made it the title of his first radio series). In the 1960s he moved across to television. A handful of his books were bestsellers, notably The Child, the Family and the Outside World (1957) and the posthumously-published case history of The Piggle (1980), a little girl he saw from the age of two years and four months until she was five. His reputation took something of a battering in 2001 when it was revealed that Masud Khan, his trainee, colleague and editor, had abused some of his patients terribly and was routinely cruel. Some of these had been referred to Khan for treatment by Winnicott. More recently, though, Winnicott has become an important figure in popular culture, in no small measure thanks to the cartoonist Alison Bechdel, the illustrator of Kahr’s book, and whose bestselling graphic memoir, Are You My Mother? (2012) foregrounds Winnicott by naming each chapter after one of his concepts. The most common complaint levied against Winnicott’s thought is that he appears to have little to say about sex. This very reticence may have secured him admirers among those who feel they’ve had a raw deal from psychoanalysis on grounds of sex and sexuality. It is not irrelevant to remark that Alison Bechdel is a gay icon. She writes a widely-syndicated strip on lesbian and gay life called Dykes to Watch Out For. And more recently Winnicott has been extolled in the poet Maggie Nelson’s analytic memoir The Argonauts (2015), a book celebrating, inter alia, transexualism and non-normative sexuality.

Although Kahr tells Winnicott a little about his posthumous reputation (and asks for his views on the Masud Khan scandal), his book’s chief focus is on how Winnicott himself saw his work in relation to his life. A remarkably coherent picture emerges. Winnicott took house jobs in children’s medicine and psychiatry and his analysis with James Strachey which he began at the age of 26 enabled him to unite the two. Unlike most of his analytic colleagues, Winnicott saw thousands of patients at Paddington Green Children’s Hospital and at the Queen’s Hospital for Children in Hackney, quite apart from his analytic consultancy. Analysis showed him that children’s illnesses were often rooted in the parent-infant relationship but he remained acutely aware that psychoanalysis wasn’t the only way of treating children or indeed adults psychotherapeutically. Winnicott was most at home playing with children. When he started out, his assumptions about play were very much in line with those set out by Melanie Klein. Klein thought that the primary function of play was to manage anxiety. When a child plays, he expresses the state of the figures in his internal world (his parents, siblings, playmates for the most part but also body parts and functions associated with these). Optimally, through play, we learn to bring the figures in our mind together creatively. Winnicott enlarged Klein’s view by suggesting that the value of play lay in its power to liberate us from object relationships as well as draw us deeper into them. It begins in what he once called ‘the area of formlessness’, meaning the zone between internal, psychic reality and the external world. The creativity of play and its potential independence from the world of objects is what makes it so important. In his biography of Winnicott, Kahr suggests that Winnicott’s love of play stemmed from his idyllic early childhood when he was doted upon not only by his mother, but also two sisters and a large staff of female servants. They, Kahr suggests, supplied the blueprint for the transitional experience that Winnicott described so powerfully in his great 1953 paper.

With the outbreak of the Second World War, Winnicott found he had no patients. Rather than fleeing to the countryside or joining the Royal Army Medical Corps, he took a post as a psychiatric consultant in Oxfordshire and the surrounding areas, caring for evacuated children. Oxfordshire was one of the most billeted areas in the country. Kahr reveals that Winnicott surreptitiously arranged to transfer his most disturbed patients from Paddington Green to hostels in the county where he would visit them once or twice a week and ‘talk to them, draw with them, [and] simply be with them’ (97). It was around this time that he developed an ambition to talk to large numbers of parents about children’s needs. One of the first things he tells Kahr over a fictional cup of tea is that he (Winnicott) grew up in a psychologically illiterate age. His wartime broadcasts and contributions to progressive magazines such as The New Era in Home and School attempted to offer the lay person the rudiments of psychoanalytically-informed psychological understanding. Anyone who reads The Child, the Family and the Outside World or the broadcasts collected in Home Is Where We Start From will recognise Winnicott’s formidable pedagogical gifts. He could make the most abstruse psychoanalytical ideas sound like common sense. Wartime enabled Winnicott to flourish in other ways too. He met his second wife, Clare Britton, a psychiatric social worker, afterwards an analyst and senior Home Office civil servant. It was with Clare that he began the work that culminated in his great paper, ‘Delinquency as a Sign of Hope’. He tells Kahr that ‘marriage to Clare enabled me to become the theoretician of play and creativity, rather than just a theoretician of madness and breakdown and misery’ (182).

It could easily have gone the other way. In 1949, he published one of his most celebrated papers, ‘Hate in the Counter-Transference’ in which he described his reactions in the analysis of a psychotic woman he’d been treating for nearly twenty years. Winnicott said in that paper that he’d had to ‘reach down into very primitive areas’ of himself in order to treat that woman and that he found himself developing something akin to psychotic symptoms in his dreams. The woman eventually committed suicide. He tells Kahr that although he hated her for being so ill, he also ‘loved her deeply, in many ways like a daughter… the closest that I ever had to having a daughter really’ (121). He thought that his experience of hatred for his patient must have mirrored her mother’s experience and that she had become schizophrenic because of ‘environmental failure’.

Kahr has written wonderfully about this case in a long article and is currently writing a whole book about it. He tells Winnicott that psychiatry has become very anti-psychoanalytic in recent decades and that the Winnicott’s ideas about schizophrenia (that it was caused by environmental failure) had not been well received. Personally I would like to send Dr Winnicott some better news by pointing out that few researchers in the field of schizophrenia research today discount the power of environmental factors. Robin Murray’s group at the Maudsley have published scores of studies on the effects of gene-environment interactions. Seymour Kety’s classic studies from the 1960s of Danish twins who had been separated at birth took place in Winnnicott’s own lifetime. Kety reported a 1% incidence of schizophrenia in the population as a whole. Being brought up by an adoptive parent with a diagnosis of schizophrenia increased the risk to 3%. Having a schizophrenic biological parent if you are brought up in an adoptive household with no schizophrenia you will gave a risk of 9%. Worst of all, having a biological schizophrenic parent and being adopted by a schizophrenic parent pushed the risk up to 17%. The bio, the psycho and the social produce synergisms that are not reducible to the bio. And epigenetic studies on attachment show the same thing. Early experience switches different parts of the genome on and off, with lasting effects. The biological is just as often an epiphenomenon of the psychosocial as the other way around. The holding environment has its role, even if that term hasn’t caught on outside psychoanalysis.

The eighth chapter of Kahr’s book, or ‘Cup 8’ as it’s called, is entitled ‘A Crash Course in Winnicottiana’ and is masterly. In it, the reader will find limpid discussions of the differences between holding, handling and object presenting and the importance of ‘good enough’ parenting (parenting that is neither so good that the infant need not develop as an individual at all, nor so bad that that he cannot). Kahr writes beautifully about Winnicott’s sensitivity to the interaction between mothers and babies. Apparently, Winnicott once told the bookseller and publisher, Harry Karnac, that babies’ minds are like blotting paper (146). They absorb everything that is put in their way. When the baby learns to use his parent, he finds that the parent acts as the blotting paper that makes the baby feel safer. ‘And then we have health’ (147).

The matter of Masud Khan is held over until the ninth cup. Understandably, Winnicott suggests he and his interviewer move on to sherry. Although he has published at least one major article on the Khan-Winnicott psychodrama, Kahr uses this chapter to articulate what he imagines Winnicott’s defence would have been. Khan’s descent into alcoholism and bouts of psychosis occurred after Winnnicott’s death. The charge sheet Kahr puts before Winnicott is very mild: ‘you had an extra-analytic relationship with him and, thus, a lack of clarity, some might argue, about the purpose of your relationship’ (173). Winnicott expresses deep sorrow in reply but says he ‘cannot offer a complete explanation of what really happened to Masud. Partly because I do not know… I knew about Masud’s difficulties – at least those that had occurred during my lifetime! And I kept meeting with him to try and work it through. He might have been much, much worse off if he had not had the analysis’ (176). Khan has been much written about so perhaps it is right that someone should attempt to look at the scandal surrounding him from Winnicott’s point of view. But I think Kahr should have put to Winnicott some of the more trenchant claims made against him. It has been said, for instance, that he was himself a serial boundary-crosser, bringing some of his most disturbed or deprived patients into his home to live with him for months on end, listening to radio programmes with analytic patients in their sessions, practising regression therapies, and that he perhaps encouraged his disciple to take a similar ‘active’, non-analytic, approach. It has also been suggested (not least by Kahr elsewhere) that Winnicott was too dependent on Khan as his ‘secretary’ to have been able to see him clearly. Kahr doesn’t disguise the extent of Winnicott’s boundary-crossing. He just doesn’t mention it in relation to Khan.

It would be hard to imagine a more congenial and convivial introduction to Winnicott’s life and work than this timely book which deserves great success, especially amongst the young who are discovering Winnicott in ever greater numbers. All his dimensions are brought out with great skill: in addition to the clinical theorist, we meet Winnicott the concert-goer, opera-lover and pianist, the painter of hand-painted Christmas cards, even the poet. One of Winnicott’s compositions contained the memorable line ‘Oh God, may I be alive when I die!’. His wish has been granted in all relevant ways in this delightful book.