Children Who Hate
Fritz Redl & David Wineman
Chapter II- Disorganization and the Breakdown of Controls
The "Control System"--Suggestions for a Purposely One-Sided View
If we read in the papers that the dam and locks on one of the wonderful reservoirs which our engineers have erected all over the country broke down and the whole force of the stored-up water flooded the valley below and caused unchecked destruction, we might have many theories as to "just what must have gone wrong." They would all boil down, though, to two basic "variables" which we might hold accountable for the event. We might assume that the dam and locks were perfectly all right, were in wonderful working order, and had been well built for the job that could be foreseen for them to perform, but that something went wrong on the "water force" side of the picture. For a variety of reasons, such an enormous and unexpected onrush of hydraulic intensity may have occurred that even the best equipped dam and waterworks arrangement could not be expected to cope with it. On the other hand, the "variable" to blame might not be the waterpower at all, and we could assume that something had gone wrong with the construction or the working order of the machinery or building material. In that case, it would not have taken an unusual and unprecedented act of nature. In fact, the water pressure might have been exactly what a normal dam of that size is supposed to cope with, but something gave way and couldn't check the force it was supposed to control. From just hearing about the flood, by the way, we could not know just which of the two situations we should hold accountable, and presumably in most cases there might be a combination of both involved.
No technological analogy should be stretched too far, for we know, of course, that human behavior is much more complex than that, but the similarity in the situation does carry us to the one point we want to make: In spite of the known complexity and multiplicity of causes in human motivation, the question as to why a particular piece of behavior occurs in a particular individual can be viewed in terms of two larger sets of "variables." One may be summarized under the term "impulsive system." By this is meant the sum total of all urges, impulses, strivings, desires, needs which seem to push in the direction of gratification, goal attainment, or expression at any one time. It is somehow held in check by what might crudely be referred to as the "control system"--by which is meant those parts of the personality which have the function and the power to decide just which of a given number of desires or strivings will or will not be permitted to reach the level of behavioral action, and in which form. Whether one child hits another over the head may be viewed with profit in a manner which bears considerable similarity to our illustration of the water reservoir, if we can force ourselves to forget for a moment the obvious dissimilarities in the picture. His hitting the child may mean that the trouble lies with his impulsivity. His reality perception, his feelings for what is fair and decent, may be as well developed in him as in the next child, and his behavior may have been due to an onrush of sudden impulsivity which "overran" his controls. On the other hand, it may be an entirely different case. He may not suffer from any such present or case history conditioned upsurge of aggression at all. He may just feel a mild urge to hit somebody, an urge no more intensive than that of another child at any one time. Only, it so happens that this youngster has no "controls" at all. The part of his personality which is supposed to screen and check his impulses before they are allowed into open action may be deficient, not functioning, or closed for the weekend.
It would not be clear which was the case if we knew only that he hit him. The direction of the "repair job," however, would be decisively influenced by finding out whether this is primarily a situation of the one or the other, or a mixture of both.
There is just one more lesson we want to squeeze out of our technological simile before we leave it alone. The engineers who are responsible for the adequate functioning of our dam and lock works would, of course, be equally interested in both of the variables we have singled out before. They would want to know exactly where the water comes from and how much of it there will be, they would want to know the "Case History" of all the tributary rivulets, and they would certainly want to estimate the potentially "traumatic" experiences which might happen on any part of the stretch and raise havoc at the control end of the line. While they make this analysis of the "water force" side of the picture, they may temporarily forget about the details of the dam and locks themselves, even though they will never forget that eventually both pictures have to be brought together. Similarly, our engineers might, at some phase of their concern, concentrate entirely on a very specific analysis of just what job the dam has to perform, which part of it has to do what, and what might go wrong with it. If we asked them to demonstrate to us, they might invite us to go with them on an inspection tour. It would not be necessary to drain the dam of water for some of this. They could show us just how the various parts of the "control system" work. They could just ask us to "ignore temporarily" the question of where the water comes from and concentrate on the control works themselves for a while. And here is where we leave our simile in a hurry. It doesn't help any more from here on. For it so happens that, in the science of human engineering, we have much more specific knowledge of the "water force" side of the picture and its case history than of the "control system" and the way it works.
And this is where this chapter comes in; we are not going to attempt to write the whole story about the "children who hate." This would be a task for many volumes, even if we used only what we have accumulated about the children with whom we worked directly. We plan to concentrate entirely on trying to describe more specifically just what functions the control system of a child has to perform in daily life, at which points it breaks down most easily, and what such breakdowns look like when they happen. We know that this is an artificial isolation of factors, which can only be justified on heuristic and didactic grounds.
The Concept of "Ego" and Our Clinical Task
Psychoanalytic theory has different names for what is in this book called, with intended colloquial looseness, the "control system." The psychoanalysts would relegate the "control" of impulsivity to two separate "systems," which constitute special "parts of our personality," the superego and the ego. Sometimes there is a third one described in psychiatric literature, the "ego ideal," but we think we can safely adopt a widespread custom of considering it as a special part of the ego and reduce the basic issue to just the two. For the non-psychiatric reader it may be explained that the "superego" is more or less the same as the "conscience." It is that part of the personality whose job it is to remind us of value issues that arise in daily living. The "ego" is supposed to "keep us in touch with reality," a statement whose specific meaning will soon be amplified. The distinction between "ego" and "superego" is not as difficult as it is made out to be. If a youngster doesn't take a dollar which just fell out of his mother's purse because he is afraid of being caught and getting thrashed, then we would say that it was his "ego" which limited his possessive urge along the line of "reality consequences." If a youngster doesn't take that dollar, even though he is certain nobody would ever find out, because he would feel bad to do anything which he considers to be a sin, such as stealing, then we would credit his "superego" with the success in impulse control. The concept of superego will be discussed more fully later. First, that peculiar agent within us which was given the name "ego" long ago by Sigmund Freud will be examined.
The history of this concept of "ego" itself would be a fascinating chapter to write.1 Suffice it to say that, from some vaguely conceived agent within our personality which desperately tries to stem the flood of the "id" impulses, as a loyal servant of the "reality principle," it has gradually developed into a much more structured "department" within our personality, whose job description can be given with relative precision. Freud himself developed this concept of the ego only late and gradually and subjected its conception to many changes and improvements. As we have pointed out earlier, it was primarily his daughter, Anna Freud, who elevated the ego and its mechanisms of defense to a respected place in therapy, especially in work with children. Since then, speculations about the intimate and not always peaceful interrelationship between the "ego" and the superego and many other details have taken increasing space in psychoanalytic literature. The growing interest of psychoanalysts in work with schizophrenics has given "ego" psychology another boost, and the need to bring psychoanalytic conceptualization closer to the action scene, which was especially increased through the development of all sorts of "group therapy," has added its push. Foregoing the fascination of portraying those details and what they mean for the therapist, we shall be satisfied with attempting to sketch what, today, are usually conceived as the "tasks of the ego."
From what Freud and his followers said, and from what can be inferred from the way they use the term in context when applying it to clinical observations, the "ego" actually is expected to fulfill at one time or another, the following functions:
I. Cognitive Function
A. COGNITIVE FUNCTION, EXTERNALIZED. It has always been conceived as one of the main tasks of the ego to establish contact with the "outside world." In this respect, it seems to be the job of the ego to size up just what the "world around us" is like, and to give adequate signals about its imminent promises or dangers to our well-being. This vague notion of "sizing up outside reality" must, of course, today be replaced by a much more specific breakdown into at least two sides of this "outside world." One is what we may call the "Physical Reality." That means, it is the job of the ego to estimate actual dangers or advantages inherent in physical situations. "I don't want to go to that dentist today," says my anxiety-ridden and comfort-greedy id. "You had better get there fast. Remember what they found out about tooth decay and dentist bills if you wait too long?" my ego is supposed to chime in. The other side of "reality demands" to which we are subject in this world might be shortly and rather crudely summarized as "Social Reality." By this is meant that the behavior of other people, individually or in groups, directly or through their institutionalized laws, customs, pressures, etc., is also a factor to be reckoned with. It is obviously also the function of the ego to become aware of existing reality limitations from that source and to give appropriate warning signals, should our behavioral urges threaten to run into conflict with them. Even a child who is clearly delinquent in his value identification, that means, one with little "superego" at all, would be expected to have his ego make a careful assessment of just in which case stealing is "safe," in which other case the very openly enjoyed and guilt-free act of stealing had better be omitted because of "reality risks" involved in discovery, capture, too threatening legal consequences, or difficulty in getting rid of the loot. In short, it is the ego's job to size up the world around us, in its physical or social aspects, and to give danger signals if any one of our desires is too seriously in conflict with the "reality outside." The term "cognitive" is taken from psychology, and it simply refers to the function of "assessing, discovering, sizing up, finding out." Our use of this term in no way implies whether the ego "finds out" consciously, or whether some of this reality appraisal remains unconscious while it takes place. We would assume both possibilities, depending on the specific situation, but the question is irrelevant for the establishment of the function itself.
B. COGNITIVE FUNCTION, INTERNALIZED. In the earlier definitions of the ego, its function of "establishing contact with the world around us," was usually emphasized. From the way the concept is now being used, though, it is obvious that an emphasis on a "cognitive appraisal of what is going on inside us" is an equally important job. In fact, some of the basic definitions of the role of psychoanalytic therapy are based on that very issue, namely, on the assumption that some id-contents cannot be got hold of by the ego, because they are repressed, that means, not even accessible to the conscious perception by the ego. If the ego doesn't even know what is going on, how can it get hold of it? This was the underlying tenor of the thinking even in the early stages of theory development leading to the demand that the repressed be made conscious. We can portray the situation implied in the following way:
COGNITIVE APPRAISAL OF ITS OWN ID. By this we mean the awareness by the ego of the most important impulses, urges, desires, strivings, fears, etc., that obviously motivate our behavior, but are not necessarily always known to us. To know as much as possible about what is really going on "in the cellar of our unconscious" always has been a primary job of the ego, if it wants to retain or regain its health. In other words, it seems that all insights, including those into ourselves, are a function of the "ego."
COGNITIVE APPRAISAL OF ITS OWN SUPEREGO. It is also one of the tasks of the ego to register "value demands" coming from within, not only to register "reality threats" coming from without. It is the job of the ego to know which behavior would run counter to what the specific personality "believes in," what its own superego considers fair or decent, or which behavior would, if allowed to go through, produce the horror of deep shame and nagging guilt. Ample evidence was produced in later psychoanalytic work to show that superego particles, too, can be unconscious and repressed. In those cases, it is the ego's job to become aware of the voice of its own conscience, and the therapist's task to help the ego onto that road. In short, "know thyself" does not only mean "know what your most secret strivings would make you do if they had a chance," but also "know what price you would have to pay in guilt feelings, should you give in to them."
II. The Power-Function of the Ego
Though not always implied in the definitions, it has always been assumed that the task of an ego that is in good working order is not only to "know" what reality demands are, but also to exert some force, so as to influence behavioral strivings in line with that knowledge. Or, in other words, if my ego is smart enough to tell me I "ought" to go to the dentist today, but not "strong" enough to get me there, it does only half its job and is not much help to me really. This "Power Function" of the ego is a most fascinating metapsychological problem, because we have so far wondered and speculated a good deal as to just where the ego is supposed to get the "power" to suppress impulses and drives. This problem was a difficult one in the early phases of theory, when the ego was supposed to be little more than a "voice" telling us about the world outside. We have come a long way since then. We have to assume, for any usable conception of the ego, that it somewhere has access to a power system and then can use whatever energies it has at its disposal to enforce the dictates of its insights upon our pleasuregreedy impulse system. By the way, this is what we should mean when we say an ego is "weak." Unfortunately, the term "weak" is also used freely to indicate simply that an ego doesn't function well. We shall limit our use of the term "ego weakness" only to those situations where a disturbance of its power function is clearly meant.
III. The Selective Function of the Ego
When confronted with an outside danger or an inner conflict, it is not enough to know what the situation is and to be ready to block inadmissible impulses--the ego has a few other decisions to make. For there is usually more than one way to react. The old idea that all the ego has to do is to decide whether an impulse can be afforded or not is an oversimplification which needed debunking long ago. Even in the most flash-like and simple situation, where the ego resorts to ready-made, stereotyped, reflex-like "defense mechanisms," it still has to select one from quite a number. Let's assume that a child suddenly becomes aware that the rest of his pals are engaged in some "dirty talk" which seems highly statusloaded in their gang but of which he doesn't understand a word because of parental overprotection and lack of sophistication. He has a variety of ways in which to react to the emerging conflict. He can deny his desire to be in on the talk. He can add "reaction formation" to this trick to make it more foolproof. Then he will get very indignant at the very insinuation that he might want to know about things like this and will even ward off his friendly therapist's help along the line of sex information. He may, on the other hand, simply withdraw, and this he may do on different levels and with varying scope. He may, for instance, simply avoid being near those bad boys; he may try not to have to play with them. On the other hand, he may ask to be transferred to a different group. Or he may have to cement his withdrawal with wild accusations and gossip propaganda against these youngsters. Finally, he may not do any of these things. He may successfully repress during daytime what is going on inside him, only to be flooded with bad dreams or night terrors, or plagued by insomnia or anxiety attacks.
Of course, our youngster doesn't have to resort to these automatic defense mechanisms at all. In that case he has to meet the problem on a reality level. Then, his ego has to make even more far-reaching decisions. Maybe he simply can tell his father and have a man-to-man talk and ask him what all those things the kids are talking about mean. Maybe he can ask another boy or his counselor. Or maybe his group skills are so well developed that he simply forces or inveigles the others into "cutting him in on it," swallowing the unavoidable transitional razzing he will get in order to solve the problem once and for all. In these cases, too, his ego will have quite a job to do. It will not only have to appraise just which of these paths are open to it but it will have to "inspect the tool by which reality is being met" as to its potential ability to solve the problem. It will have something like a "tool selection job in terms of efficiency appraisal" to perform.
This "selective function" of the ego has not been sufficiently dealt with in psychiatric literature. It is usually thrown into the general chapter on "reality testing." We think that it is important to differentiate between the testing of the reality to which the child has to adjust and the testing of the techniques and their realityrelatedness by which the child tries to bring about this adjustment. In the study of the "children who hate," the disturbance of this function becomes painfully obvious. We would like to see it established as an ego function in its own right.
IV. The Synthetic Function of the Ego
The concept of a synthetic function, a much later addition to ego psychology, has led into fascinating but also specifically metapsychological speculations. One of the latest studies around this issue is that of Nunberg.2 Here, we do not want to enter into such metapsychological speculations. We are using the term "synthetic function" in a somewhat simplified way. This is what we have in mind: if we assume that there are a number of "parts of the personality" at work, each one apparently equipped with some "influence" in the internal household affairs, then the job of putting them all together and keeping them in some sort of balance with each other must somewhere be ascribed to "somebody" in the picture. We suggest that the ego be given this task. In other words, it is also the ego's job to decide just how much a personality shall be predominantly influenced by the demands of the impulse system, the demands of outside reality, the dictates of its own conscience. It seems that "personality disbalance" can result from any one of a number of "wrong" assortments of power distribution. For instance, if the superego is allowed to dominate far beyond what an individual can sacrifice and still remain healthy and happy, you get a virtuous person, who will finally break down under his own frustrations or have to become hostile and nasty for the same reason. On the other hand, if impulsivity is entirely rampant, the present state of happiness will soon be destroyed by the conflict with the "outside world" which may result in lifelong incarceration, or by the "nagging guilt" from within, if too strongly established value issues are allowed to be violated by a too little vigilant ego. In brief, it is the job of the ego to balance the various demand systems and to keep this balance "reasonable" on all sides. We think, by the way, that the term "balanced personality" should be reserved for this issue rather than be used as widely as is currently the custom. The most glaring illustration of a one-sided handling of the synthetic function by the ego is the one which will engage us soon, namely, the case where the ego throws its weight entirely on the side of impulsivity or of a delinquency-identified superego--a situational distortion for which we plan to use the term "delinquent ego.
It seems, from all this, that the "ego" has to cover quite a wide variety of functions. We think that a rebuilding of the whole personality "model" is long overdue.3 For the duration of this book, however, we prefer to stick with this somewhat widened but basically unchanged conceptual system, for reasons of traditional convenience.
Ego Psychology and the Practitioner
The therapist dealing primarily with adult cases belonging in the realm of classical anxiety and compulsion neuroses, hysterias, and their close relatives, and operating within the framework of the interview technique on the couch, has been late in developing his interest in ego psychology. Not that the basic concept of the ego as developed by Freud had not always been taken for granted. But there was little need for him to elaborate much further on it. Indeed, most of those people whose disturbance falls into the description above have their egos pretty well intact, with the exception, of course, that it is over-ridden by their libidinous pathology in the special area of their disease. The therapist is interested, therefore, in the shenanigans of the ego only in so far as it hits his treatment scene along the line of resistance and defense, and he has learned how to deal with it there. Only in recent years has there been a sudden upsurge of interest in "ego psychology" and the need for it is especially felt by those who are trying their hand with more mixed disturbance types, or with character disturbances and psychoses, or who deal with patients over whose life they assume partial responsibility by being attached to organizations like hospitals or the armed forces.
The therapist dealing with children has had his fascination for ego psychology stirred up long ago. Since Anna Freud's classic book, the respect for ego psychology can be said to be an earmark of the psychoanalytic school, as contrasted with those watered-down psychotherapies which still indulge in the old pre-Anna Freudian delusion of "therapy through total permissiveness of libidinous discharge." It is interesting, by the way, that the public at large is not aware of this at all and, contrariwise, is inclined to assume the total permissiveness idea to be more typical of the orthodox Freudian child analysis. As long as the child analyst confines his work to selected classical cases of anxiety neurosis, compulsion neurosis and the like, and some character disturbances produced on the upper middle-class market, the interest in the "ego" is still relatively limited. The emphasis on ego psychology is primarily important in order to protect the integrity of ego needs on the natural life scene of the child. It is also a warning to the therapist not to forget that children's egos, like their superegos, are still growing and being shaped, and a reminder that even in the pure job of treatment, so far as children are concerned, "ego support" may be an important task, not of the educator only, but of the therapist himself. Valuable additions to our knowledge of "ego development" are due to this emphasis on ego psychology in the classical child analysis. The trouble here is not the emphasis but the total shrinkage of the field itself. With the narrowing down of trained child analysts in the United States numerically to a negligible handful, and with the reduction of even their practice to only a small children's load, this source of additional material for ego psychology has practically been drained off.
The situation is nearly reversed as soon as we leave the therapist who functions in a protectively designed office, couch or play therapy framework, and talk about the "practitioner" in terms of the people who somewhere have to survive with the surface behavior of children in the raw. In this category fall all the parents, the teachers, group workers, recreation leaders, workers in children's institutions, and also all those workers on the margin or in the midst of the clinical scene, who are more heavily loaded with direct responsibility for child behavior than the therapist in his classical role. This includes, then, police officers, probation workers, social case workers, clinical psychologists and psychiatrists affiliated with schools and institutions where children live. Workers and psychiatrists in social agencies and child guidance clinics and the like also partly belong in this category because of their wide-open case load. Even where their task may be limited to special therapy like that of the child analyst, they are not able to select the cases with classical problem syndromes for which psychoanalytic therapy was originally designed. They are flooded with cases which they feel don't really quite "belong" to them, such as open delinquents, pre-psychotics, schizophrenic children, or the secondary emotional and behavioral implications rising on the grounds of physical handicaps, epilepsy, etc. They are, of course, also flooded by the deluge of behavior syndromes which somewhere are classified as "character neuroses," "primary behavior disorders," "psychopathic states," or just "personality disturbances," for lack of an open admission that we don't know what's wrong with them.
The moment workers are saddled with such cases, their proximity to the behavioral scene comes close to that of the parent or teacher. In direct proportion to this proximity their interest in what we called the "control system" goes way up. For there is, indeed, little material available on this question. We know more about just why children want to do what they do, and what caused them to get that way, so far as the specific content of their urges, impulses, and emotions is concerned. We have few publications that give us concrete information about just what it looks like when a youngster's control system is out of joint, or what techniques on our side would be directly supportive of the ego over and beyond what we can do in a straight therapy situation in terms of verbal ego support.
It is because of this helplessness which the total field is in, the moment it comes to a specific knowledge of the functioning, the pathology, and the instrumentology of ego disturbances, that we have decided to give this book such a heavy slant in that direction.
The reasons that the "practitioner" who also works in the fox holes of child behavior in the raw is so concerned with more data on ego psychology and the functioning of controls seem to flow out of three facts:
Even in cases which are being treated in classical psychoanalytic detachment from the scenes of daily life, somebody in the framework of their natural habitat has to survive with the symptoms as long as they last. This somebody may be the child's parent or foster parent. It may be his group leader, teacher, housemother. It may also be the other child in his group, in his block, in his dormitory. Now, survival with a child's symptoms is strongly dependent on just how much of the child's ego is still intact. And, where it is not, we have to plan just how his life frame must be manipulated, how his behavior must be handled, so that the child and others around him can still exist. Somebody will have to react to the child's behavior. Even though this reaction is not meant to be part of the "real therapy," it has to be efficient at the same time that it remains "hygienic." Those who live with the child, therefore, will have to know, and those who do their special tricks in their own interview work will usually have to tell them, not only why the child got that way and why he feels he wants to "set the joint afire," but also, just what you do when he tries. They will have to help them to find out how to stop him without injuring their relationship to him, just what life situations his ego might manage without losing control, which other life constellations would throw it into confusion. They will want to know under what conditions his pathology can be expected to remain safely dormant, which others lure it into uncheckable acting-out.
Wherever the therapist enters an "action frame of life," as in a clinical camp, a therapy club, a treatment home, the issue of "symptom survival," of course, becomes even more directly his concern. The very process of therapy may have to be modified because of this. It is one thing to encourage a child to claw out the doll-sibling's eyes. They can easily be replaced. But none of us would advise this as clinical strategy where a live prop is involved, like another child in a therapy group. Yet, the therapist obviously could not forbid the youngster to have such desires, or to express them. He would be eager, however, to give the youngster enough "ego support" so that he can keep them on a "fantasy level."
In short, without knowing more than we do know about just how the "control machinery" works, our advice to parents and child practitioners in the field of daily life would be bound to remain general, vague, and not very helpful. And our own ability to handle more children in life-involved therapy situations would be in desperate straits.
Developmental and Educational Support
All children, even children in treatment, go through certain clearly marked "developmental phases" with their own tasks and their own problem. In this process, especially in highly "transitional moments" from one phase to the other, the "control" system also undergoes changes and finds itself suddenly confronted with an enormous task. We know this especially well from the study of the transition from later childhood to early pre-adolescence, and again at the onset of sexual maturation around puberty. Just what happens to the ego at that time, which of its functions will have to be supported or even substituted for, and what internal changes can be expected to occur? Current publications have a tendency to focus more on a description of the transition through the oral, anal, and genital phases of libido development than on the question of just what happens to the ego at the time. The very phrase "latency period," by the way, which has been so frequently picked up even by non-psychoanalytic literature, betrays the lopsidedness of this approach. For "latency" simply refers to the fact that open sex exploration is temporarily less active than it has been in the preceding stages. What an odd way of naming a phase after what is not happening in it! We would be as interested in the question of just what else is going on, and what happens to the ego of the child at the same time, as in the fact that libido development seems "latent." And a good deal happens to it, indeed, and ego support is one of the primary tasks of the educator, especially during transitional phases. How can we know how to support something the specific nature of which we haven't adequately explored?
Beyond this, all children, whether in treatment or not, require "educational support." They have a learning task to fulfill, in order to become normal members of the adult group in a specific culture. Not all this learning is directly related to the oral, anal, genital phase issues and the very agent which controls most of the "reality contact," the ego, is of course heavily involved. Especially the acquisition of sensitivity toward and of skills in dealing with what we called the "social reality" requires an enrichment and growth of the ego far beyond its earlier childhood stage. What can be done to support the ego, even that of a child with some pathology along other lines, to do its educational, acculturational job efficiently? How can an ego be helped to remain in good touch with reality and in good condition in the area of learning which it would have to undergo anyway even though and even while some other part of its pathology is being worked on? Or where are social protective measures needed, and just what is the "post surgical job" to be done to a youngster whose childhood neurosis has kept him from adequate social contacts, who is now free to start them, but who has missed the necessary ego development in that area in the meantime? The therapists will have to be interested in that, even where they direct other people to do that job. The "practitioner in the fox hole" can hardly live a day without hoping for more knowledge of the "control system" all along the way.
Bruno Bettelheim's term is originally meant to imply the exposure of a child to total environmental design for treatment.4 It may also be conceived on a partial basis, in so far as we think a child's problem requires his placement in a foster home, the exposure to a therapy group every Wednesday afternoon, or the summer experience of a specially designed camp. In all cases we expect "environmental stimuli" to do the treatment job with us or for us. Whether partial or total, whether supportive or direct, in all those cases we want to design at least a piece of the child's environment so as to fit the whole child in a treatment-favorable way. We deal with the whole child in a total life situation even if only for a short time span, and with children this invariably means acting, not talking or fantasying only. In short, the problem of reality-contact and the question of control functions are immediately involved. How can we gauge, for instance, just how much encouragement a child should have to "admit his hostility against his brother" to himself, before we know whether his ego is in good enough shape to keep such hostility within limits, or whether it is disturbed enough so that he may have to try to choke that child to death? How do we know just how much of the need for aggressive expression should be allowed into the open, before we know which game structure will help the child's partially disabled ego to keep impulses on a halfway bearable sublimation level? How can we tell when to confront a child with the awareness of his "fault" before we know how his ego will react to shame and guilt and how much of these it can bear without breaking down entirely?
In short, the very attempt to treat children in and through environmental settings opens up a wide avenue of therapeutic enrichment, undreamt of before. At the same time, it also requires as an important condition more knowledge of the "control machinery" and its areas of disturbance and of techniques of supporting and repairing it.
The most vital urgency for more data on ego psychology, however, is presented by the "children who hate." It seems to us that some of their basic pathology is intimately tied up with direct disturbances of the ego functions to begin with and, where their disturbances are limited to the impulse system itself, the problem of supporting their ego so as to survive "treatment shock" becomes a new issue in its own right. It seems to us that any of these children can be approached successfully only with a total treatment design available. In order to attack some of their direct ego disturbances, more knowledge about just what is disturbed to begin with is mandatory. It is for this reason that we want to focus now primarily on the description of some of the disturbances of ego function which we could observe in the Pioneers and in hundreds of other children, while we had the chance to live with them.
1 A most comprehensive discussion of the psychoanalytic theory of ego will be found in Heinz Hartmann's paper, "Comments on the Psychoanalytic Theory of Ego," The Psychoanalytic Study of the Child, V. (New York: International Universities Press, 1950). In it there is also reference to other important contributions by Paul Federn, Thomas French, Anna and Sigmund Freud, Edward Glover, Ernst Kris, Hermann Nunberg, Robert Waelder and others. See also Richard Sterba, "The Fate of the Ego in Psychoanalytic Therapy," International Journal of Psychoanalysis, XV, (1934).
2 Hermann Nunberg, "The Synthetic Function of the Ego," International Journal of Psychoanalysis, XII, (1931).
3 Interesting steps in the direction of a new design seem to be taken in Erik H. Erikson's Childhood and Society (New York: W. W. Norton and Company, Inc., 1950).
4 Bruno Bettelheim and Emmy Sylvester, "The Therapeutic Milieu," American Journal of Orthopsychiatry, XVIII, (1948), 191-206. See also, by the same authors, "Milieu Therapy," Psychoanalytic Review, XXXVI, (1949), 54-68.
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