"Pathological Symbiosis" in LVU
- Relevance, and Sex Segregated Emergence

by Peter Klevius (2004).

Abstract: “Pathological symbiosis” is a psychoanalytic concept that is incorporated 1991 as a legal criterion for compulsory separation of children from their parents. The purpose of the study is: a) To elucidate whether “pathological symbiosis” is familiar and relevant for social welfare secretaries, b) to present research on risk and prevention, c) to understand the emergence of “pathological symbiosis” in the light of sex segregated opportunity structures and traditional sex role attitudes affecting main female child psychoanalysts. The questions addressed are: 1) Is the concept of “pathological symbiosis” familiar and relevant for social workers in Stockholm?

2) Can the emergence of the concept be better understood as a result of  sex segregation? The first question is answered by a semi-structured survey among 18 social districts in Stockholm in the fall of 2002. The latter questions are answered by a hermeneutical method. Data from the writings of main critics of the psychoanalytic movement, as well as from original psychoanalytic authors and their biographical material are included. The study focuses on Margaret Mahler as the main author associated with the concept and Anna Freud. According to 17 out of 18 social welfare officers, representing one district each, “pathological symbiosis” is a necessary and usable tool for their work with children. The main interpretation of the hermeneutical understanding is that the emergence of “pathological symbiosis” is intimately connected to sex segregated opportunity structures and traditional sex-roles. Research on risk and prevention suggests the lack of parental attachment as a major cause of deviancy.


1. Background and Introduction. 1

1.1 Compulsory care of children (LVU) 1

1.2 A discreet incorporation of “pathological symbiosis” in LVU.. 6

1.3 Two examples of “pathological symbiosis”. 7

1.3.1 The wealthy symbiotic mother 7

1.3.2 The poor symbiotic mother 9

1.4 Attachment 10

1.5 Psycho-social “mother fixation” and sex segregation. 12

1.6 Deviance and social control 14

2. Purpose, Problem and Method. 16

2.1 Purpose and problem.. 16

2.2 Method and outline of the study. 17

3. “Pathological Symbiosis” in a Social Setting. 21

3.1 Survey among social welfare secretaries in Stockholm.. 21

3.2 Research on risk and prevention. 24

3.2.1 Social bond and attachment to parents. 27

3.3 Symbiosis in psychoanalytic epistemology. 29

3.4 The emergence of “pathological symbiosis”. 30

3.4.1 Early child psychoanalysts. 30

3.4.2 “Black Devil” mothering the “frail child”. 31

3.4.3 An un-analyzable, “sticky libido” “disturbed by motherhood”. 35

3.4.4 Main characteristics of pioneering child psychoanalysts. 42

4. Results and Main Interpretation. 47

References. 48

Appendix. 56

1. Background and Introduction
1.1 Compulsory care of children (LVU)

My experience as a legal representative in cases concerning compulsory care of children has made me aware of the subjective usage of psychological concepts. This concern seems to get psychosocial support from S. Hessle, social work support from B. Edvardsson and judicial support from A. Hollander below. In ‘Angels of Antichrist’ (P. Klevius 1996) a concern of sex segregation within the public sector was added to these concerns (also see G. Esping-Andersen 1990, M. Alestalo, S. Bislev & B. Furaker 1991, M. Charles 1992). Traditional sex roles seem to have been transferred to the welfare state. According to H. Hernes the family has gone public (1987:125). HyperDictionary defines sex segregation as synonymous with Purdah, i.e. a Hindu or Moslem system of keeping women secluded, in solitude, and in a state of social isolation (2004). However, it should be noted that it seems that the concept is used in a broad sense and that it is not necessarily tied to compulsion. Sex segregation is here seen as external or internal forms of resistance against a gradual integration of the social structure that girls and women[1] are isolated from, or voluntarily or structurally isolates them from. According to M. Kalmijn, social interaction in non-romantic relationships in the Netherlands rarely crosses the gender lines (2001). Sex segregation starts earlier among girls (E. Maccoby 1988) and lack of opportunity structures seem to have considerable impact (M. Kalmijn 2001). This may foster in-group feelings, gender stereotypes and traditional sex-role attitudes (E. Maccoby 1988, C. Ridgeway & L. Smith-Lovin 1999). Sex segregation from 62 percent up to 75 percent (non-kin) was recorded in adults (P. Marsden 1990 in M. Kalmijn 2001). The heavy influence of traditional sex-roles on work with children at risk now seems to get strong support from within the system itself in a report from the Social Board that questions equality in social services (Socialstyrelsen 2004). This study focuses on the emergence of the psychoanalytic concept of “pathological symbiosis” and tries to understand it within a pattern of lagging sex segregation (traditional sex roles). A popular but subjective psychological concept[2] might have dispersed into a collective discourse/interpretation of something that does not even exist. Furthermore, in a sex segregated society where mothers on the one hand still have to carry the heavy burden of “motherhood” as an important part of their “femininity” and, on the other hand, have to work full-time away from their children, a feel of guilt and a mechanism of defence seem inevitable. Such a defence hence may include the creation of a scapegoat, a description of a motherhood that is “too attached” with the child.

To my knowledge the Swedish legislator has not as yet addressed the question of whether a too far going emphasis on the protection of children against their potentially dangerous parents may cause negative control damage[3] that possibly even outnumbers the positive effects. This question is especially well motivated when one considers the result from a quantitative study on grown up foster children, which falsifies the notion of long-term foster care as reducing developmental risks compared to growing up in “insufficient” family environments (B. Vinnerjung 1996:315). Furthermore the amount of subjectivity that is allowed and even a necessary result of a not too well articulated regulation is another source of uncertainty. According to S. Hessle, a professor in social work, there are few topics where the cleft between expressed, self-evident conviction and empirical facts are as wide as regarding “child neglect and abuse”. Accompanied by media different caring ideologies change from one extreme into another in a couple of years (1988:14). Furthermore, official child protection policies are by necessity biased against parents and in favour of, not only its own interpretation of “the best interest of the child”, but also the child protection system itself[4], thus, in the end, possibly counterproductive to its alleged aim.

There seems to be limited possibilities within the scope of this work to trace “pathological symbiosis” in County and Administrative Courts because it supposes that one reads thousands of court rulings and included reports. Furthermore it seems that “pathological symbiosis” may also be described with other terms. The main reasons for the choice of subject for this study are:

·        the text in the Swedish child protection act LVU (Act Containing Special Regulations Concerning the Care of Young Persons) – now including[5] the term “pathological symbiosis” – stays in an obvious opposition to the view expressed in the UN Convention on the Rights of the Child (SOU 1986/20:304).

·         if “pathological symbiosis” is not a well defined and/or well understood concept there is an obvious risk that measures made in the best interest of the child are counterproductive.

LVU implies total limitations on the child’s rights[6] and severe limitations on the parents’ rights on decisions concerning the child’s life in its home. Consequently it is extremely important that no mistake is made on the part of the social welfare committee (SoS report 1990:24). Decisions on care according to LVU are approved by county courts after notification via the social services. But, according to A. Hollander, a vaguely formulated act and detailed rules for action do not constitute a guarantee that the child’s needs are fulfilled[7]. The study of a number of child custody cases has revealed the importance of recognizing the problem of evidence and interpretation: “It cannot be considered sufficient to confirm that there are documented bad conditions in the home. Facts concerning the connections between these conditions and the ‘danger’ for the child’s health and development must be clarified” (1985:299). Facts in childcare cases generally have to do with the mother and her alleged weaknesses. Issues of evidence focus on these facts, while other factors in the child’s environment are neglected. In conclusion the legislation seems to be more coercive against parents rather than in the best interest of the child. It also became clear evident from the precedents of both the Supreme Administrative Court and the application of the act in lower courts of appeal that the motives for taking children into care are increasingly formulated in child psychiatric terminology. The motives are also getting more diffuse (1985:369-370). Furthermore it is a fact that Sweden has a higher rate of children in care than the other Nordic countries where the legal regulation is similar and other social conditions comparable. We do not know the reason for this[8] (ibid. 1985: 355).

The proposal for a new LTU (Lag om tvångsvård av unga – Act concerning compulsory care of young persons) replacing LVU, out-lined in SOU 1986:20 Barns behov och föräldrars rätt (Public Reports of the State 1986:20, The Needs of Children and the Rights of Parents), suggests the omitting of the concept of “some other condition in the home”, and directly stating in the text of the act, “abuse and exploitation”[9]. These conditions, which also are mentioned in the UN Convention on the Right of the Child, were originally intended by the concept “some other conditions in the home”. By mentioning them directly in the text of the act they would become more elucidated. This would also eliminate uncertainties regarding which other situations, except neglect, that could bring about compulsory care of a child. The new, simplified expression in the proposed but later dismissed LTU would then be consistent with the UN formulation (SOU 1986:20). However, instead of removing the concept “some other conditions in the home”, this title now contains a variety of new concepts[10], such as e.g. ”pathological symbiosis”.

An investigation that forms the basis for a decision according to LVU must be objective, impartial and worked through in accordance with true facts[11]. Implications for child welfare legislation, policy, and practice, however, may differ considerably depending on theoretical and ideological preferences (B. Vinnerjung 1996:316). Because the taking of a child into compulsory care may affect the investigator emotionally, the investigation should proceed by the aid of a critical-objective method involving a number of basic criteria, which have to be met. Failure to meet with these criteria causes partial investigations lacking in objectivity and characterized by the fabrication of evidence with the intention of influencing and persuading the reader, and supporting the investigator’s own purposes. Defective investigations leading to questionable decisions might in the end destroy the future of the family and the child (B. Edvardsson 1996).

The danger to the child’s health that is a condition for compulsory public care need not be serious, and no detrimental effects have to be established. Here “the psychiatric apartness” of the parents – their special mental character – and their “personal disposition” are crucial. The expansion of the social bureaucracy entrusted with these tasks took place during the 1970’s (J. Sundberg 1995:6, 13). The ideology seems to have been that the less time that people spend together in the family, the less chance there is that the evil, wrongful influence is exercised that entails unhappy consequences (ibid. 8-9). Furthermore, the clear-cut descriptions of criminal acts have no equivalent in cases concerning the conditions in which children are brought up. A legal procedure in these cases is as if we, in a criminal case, should ask whether a crime has been committed or not (K. Vinterhed et al 1981:177).  It also seems that the “psychological gap” in the parent’s defence has been abused on extremely loose grounds by the social authorities. Without knowing the facts in the case, experts’ opinions against the parents are delivered (ibid. 178).

A considerable industry of foster parenting[12] and an ambivalence built into that system, have forced people towards a rigid, dichotomist thinking resulting in different “schools”. The “Anna Freud-Joseph Goldstein-Albert Solnit”[13] school emphasizes the separation of the child from allegedly deviant parents. This “The-Right-of-the-Child-movement”, inspired BRIS (Children’s Rights in the Society) in Sweden and introduced the concept of “psychological parents” (K. Vinterhed et al 1981:82-85) as an alternative to the biological parents. BRIS is also one of the two bodies that asked for the inclusion of “pathological symbiosis” in the renewed LVU of 1990.

1.2 A discreet incorporation of “pathological symbiosis” in LVU

The Public Report on child protection 1986:20, Needs of Children and Rights of Parents mentioned above emphasizes the risk of separation, and the need for continuing relation between parent and child. Nonetheless, in the final proposal (Prop. 1989/90:28 p. 108[14]), the concept of ”pathological symbiosis” appears. Christina Gynnå, who wrote the text in the proposal, unfortunately does not seem to recall[15] the concept. Although the head of the department[16] states that the new act does not differ from its predecessor (Prop. 1989/90:28 p 106) the introduction – though with a minimum of text – is referred to as based on several – in fact two – answers from bodies to which the proposed measure was submitted. These two bodies contributed with a total of four words associated with the new concept[17]. According to BRIS (Children’s Rights in the Society) – an association closely associated with the theories of Anna Freud – psychologically defined destructive relations between parents and children, for example “symbiosis”, constitute the very foundation for child protection (BRIS 1987:5) Furthermore there seems to have been no discussion about the concept during the legislative process. As a consequence LVU (1990)[18] now states that, except in cases of abuse, exploitation and neglect, a child should also be taken into custody because of  ”…some other condition in the home…”, e.g. “pathological symbiosis”. In conclusion we end up with a concept that is not defined or outlined, but, on the contrary, hidden, outside the text of the act, in the preparatory works on one line on one single page and without any references to research, reports etc. Furthermore its existence is not trivial but legally powerful because it exemplifies the word “other” in the text of the act. Even if its legal usage is left aside, the very existence may be disastrous when considering the uneven power balance between the social welfare secretary and the child and its anxious parent.

1.3 Two examples of “pathological symbiosis”
1.3.1 The wealthy symbiotic mother

According to P. J Caplan mother-blaming in the form of “maternal deprivation” most often lacks the follow-up questions regarding “cultural deprivation” in the form of:

…deprivation of mother-infant closeness by a culture that is obsessed with the importance of separation and individuation and pathologies closeness, connection, and interdependence to the point that mothers pull away from their children out of fear that their love and closeness will damage them. Related to this point, I would suggest that the use of terms like mother-daughter “fusion”, “enmeshment”, and “symbiosis” no longer be used, since they promote this kind of misguided pathologizing (P. J. Caplan 1990:62).

A woman approached J. Caplan after her talk and agreed about everything she had said - except for her own mother. J. Caplan concludes: ”North America seems to be filled with daughters, each of whom believes that her mother is the world’s only masochist. What kind of culture encourages such mother-blaming (1990:63)?

Professor in social work S. Hessle[19] became interested in a case of child protection involving a wealthy and well-educated journalist and her son who was abducted from school by the help of the police and placed on an isolated island together with an abusive, criminal and drug addict foster parent. The case became widely heard of not the least because of the attention it received from outside Sweden with the help of the human rights fighter, Amnesty International activist and ”prisoner’s angel”, Birgitta Wolf. According to S. Hessle this case exemplifies a violation of the right to bridge the generational gap and constitutes the tip of an iceberg that reveals an ideological altering toward contempt and indifference in dealing with the most fragile of relations, namely that between parent and child. In its grotesque and naked plainness its management represents not only the stiffness and insensitiveness of our system of society, when confronting eternal variations and emotions of human life. The case also expresses a cynical approach towards individuals who refuse to adjust them to the ideological pattern forced upon them by ideological ”experts” and bureaucrats (S. Hessle 2002).

According to the mother, her son was completely isolated from her. “We were not allowed to talk to each other over the telephone, not to meet, and not even to write letters. I was told that my influence over my son was too dangerous” (M. Niskasaari 2002).

According to the book[20] the mother wrote about the case, the foster father was an alcoholic and cruel sadist who kept the boy for long periods of time without letting him to school or offering complementary home-education. Despite the mother’s relentless pursuits complemented with the help of friends and private investigators, it took five years, and many efforts, before the boy succeeded to escape while the foster father laid drunk. Suddenly all the legal measures taken to protect the child against her mother, were forgotten and erased (M. Niskasaari 1996).

1.3.2 The poor symbiotic mother

A 14 year old boy died alone at night in a foster home after having suffered a massive series of epileptic attacks. According to his mother, she and her son had been denied a meaningful way of communication during the last three years of his life. Allegedly there was a symbiotic binding which had to be eliminated by decreasing the contact between mother and child. M. Zaremba cites from the social report the re-definition of the problems of the epileptic boy: “Marianne has relational problems of her own and thereby also Daniel has been affected by the mother’s inability to feel confidence and attach in relations”. This document is important because it is the equivalent of the medical case-book and therefore should fulfil requirements of objectivity[21] and completeness (M. Zaremba 1993)[22]. The boy’s physical disease is never mentioned again in the summaries of the social authority’s reports. The connection between the boy’s hormonal disturbance and ambivalence toward his mother disappears forever. It is, according to the social authorities, the mother who makes him feel ill because of symbiotic bindings, erroneous patterns of up-bringing, and a fixation for diseases. “Daniel is not that sick, it is only the imagination of Marianne”, says the social welfare secretary whose task it was to protect the child, two months before his death. In this and the case above, the children were neglected and abused (physically, psychologically and sexually[23] – my comment) in the system supposed to help them. Accordingly they could not count on any help from the social authorities (M. Zaremba 1993). According to the mother herself she was not a drug abuser nor asocial. The care decision rested entirely on symbiotic bindings supported by other psychological terms. In a comment to the death of the boy, the social authorities states: “The night was not extreme. Daniel has suffered from 40 cramps previously without dying” (M. Sigström)!

Daniel wrote letters to his mother complaining about: the physical, psychological and sexual abuse; the neglect; the fact that his correspondence was scrutinized; that his calls were intercepted, and that he was forced to apologize for what he had said about the family in front of the psychologist. Daniel’s mother sent the letters on to the social authorities. She received the following answer[24]: “The letters from Daniel that you have distributed to the social committee does not alter our assessment in the case. Furthermore we question whether it is appropriate, in this manner, to hand over the letters from Daniel that he, in confidence, has written for You.” And when Daniel, because of being the target for sexual abuse, temporarily was evacuated to a woman’s home, she called the social authorities asking what to do when a person gets epileptic attacks. “Pat him on his cheek” was the advice she got (M. Zaremba 1993)[25].

1.4 Attachment

Attachment and symbiosis are here considered as mainly synonymous and positive, as opposed to the negative “pathological symbiosis”. According to a psychological dictionary from the 1980’s, attachment is defined as “an emotional attraction or dependence between two persons”, and symbiosis as “a close, sometimes neurotic, attachment of one individual for another” (J. P. Chaplin 1984). Hence “pathological symbiosis” may be seen as a reversal of attachment.

Patterns of attachment in human societies may differ considerably. !Kung gatherer-hunter children can be treated indulgently because they are raised within multi-aged groups consisting of relatives and friends quite unlike the relative isolation of modern mothers and children (M. J. Konner 1976:220). In the light of studies among gatherer-hunters, recommendations encouraging less maternal attachment must be viewed with scepticism (ibid 242). One has to realize the fact that primates and gatherer-hunters most likely live in a tight kinship group, not a group consisting of arbitrary individuals. From an individualistic Western point of view the quality differences between different types of “groups” might easily be underestimated. According to M. J. Konner the developmental course of attachment in mother-infant pairs paradoxically shows that when mothers and infants live in a familiar group it results in decreased proximity seeking and other dependency demands at later age. The relationship between early indulgence of dependency and later reduced dependency “runs so contrary to classical notions of reinforcement and even common sense that even with convincing evidence it is difficult to accept”. Whereas an ordinary theoretical model would predict that reward of dependent behaviour with satisfaction of the infant’s needs, would increase the behaviour, the reverse is actually the case and quite the contrary to the “spoiling”[26] model of Spock[27]. The view most pertinent to the human data is that others present affect the infant’s relation with its mother. Whereas the !Kung mother-infant pair in the band context roughly resembles that of the group-living monkey pairs, the Western middle-class mother-infant pair resembles that of  isolated monkey pairs. M. J. Konner refers to an experiment where squirrel monkey infants were placed in a choice situation where they could be close to their mothers, a strange adult female, a strange infant or an empty cage. The test revealed that the kin-reared infants showed a greater attachment for their own mothers than did the isolate-pair infant. According to the authors this indicated “preference” and “closeness” of the relationship.(1976:240-241).

1.5 Psycho-social “mother fixation” and sex segregation

According to research referred to in a new report from The Social Board in Sweden, social authorities are characterized by “mother fixation” related to women’s dominance. 80 percent of the social welfare secretaries and most of the parents involved are women. A child welfare investigation hence is mainly “an affair between women” where social welfare secretaries reproduce sex differences and traditional beliefs on sex roles. Social work hence contributes to the reproduction and confirmation of sex differences. “Mother focusing” also leads to an emphasis on mother-child relations and mothers are mainly or solely blamed for being responsible for insufficient care whereas fathers are considered not fully adequate as parents. According to the report the consequence of this female domination, however, seems to be unclear  (Socialstyrelsen 2004:74-102).

Judith Butler questions the dichotomy of sex and presupposes that masculine and feminine are not dispositions[28]. One of the most anxious aims of desire is hence to elaborate the difference between him and her, and to discover and install proof of that difference[29] (1997:132-137). As a conclusion Butler establishes that what is called power is in fact what makes one’s ambivalent emergence possible and, subsequently, a strict identity impossible (ibid. 198).

According to Karen Horney, an early psychoanalyst, it is definitively unsatisfactory that half of the population is discontented with its sex (J. Sayers 1992:100).  Thus “the pathos of exclusion as the ‘ground’ of feminism” (J. Butler 1997b:42-43) seems problematic. As noted by M. J. Buhle, radical feminists like Firestone advocated for the eradication of all markers of sexual difference to the extent that genital differences between human beings no longer matter culturally. Contemporary psychoanalysts, however, did not enjoy this revolution too much (1998:219) but rather followed S. Freud whose misogyny was rather representative for the Viennese fin d’siecle and, according to H. H. Ellenberger, its strong emphasis on male domination. Women who wore their hair short were hardly to be found and even in mixed social gatherings men and women resided in different parts of the rooms (H. H. Ellenberger 1970:255). The beginning of the 20th century experienced a flight from all what three generations of activists had sought for women and a return to an emphasise on the differences between the sexes (M. J. Buhle 1998:354). S. Freud seems to have taken “the natural inferiority of woman for granted” and according to Laura Marholm[30] and Otto Weininger the goal of women was to gratify man’s desires (H. H. Ellenberger 1970:292-293). This could, according to M. J. Buhle, be seen as the central contradiction of modern feminism[31] (1998:354). A proper gender identity became especially emphasized at the UCLA Gender Identity Research Clinic because of the research made by J. M. Mooney according to which the determination of gender identity is post-natal and cultural. These “culturalist” ideas then emerged with psychoanalytic ideas about mother-infant symbiosis and relations. M. Mahler was at the helm of this new mother-infant relationship research that focused on the need for the child’s self to separate from the mother to gain a proper sense of gender (M. J. Buhle 1998:246-248).

S. Freud’s most uncompromising proposition is that the distinction of men and women is the most significant that exists. Both psychoanalysis and feminism build on this premise. Feminism and psychoanalysis have in fact developed in a continuous, intertwined dialogue with each other  (M. J. Buhle 1998:3).

Because of a vast and worldwide variation in traits and behaviour linked to masculinity and femininity, K. Horney ultimately resolved to what could be named a cultural theory of femininity. Psychoanalysis hence was the main tool for assisting women to adjust to the new requirements of modern society. Women suffered the malady of “boy-craziness”, i.e. an obsession with love and romance because of an “inherited tradition” that had compressed their numerous possibilities into the “narrower sphere of eroticism and motherhood”. Sexual intercourse for these women is a neurotic aspiration of the elixir of life that is accessible only through men  (M. J. Buhle 1998:111-112). But although S. Freud offered the cure of “a normal penis several times” for hysteric women as fundamental for the understanding of psychoanalysis (1989:73-74), “the virtual author of sexual modernism” wrote surprisingly little about femininity (M. J. Buhle 1998:29) and K. Horney, on her part, decided that femininity as such does not even exist and is merely a disguise. S. Freud advised that an individual woman may also be a human being, which statement K. Horney considered a “relief” in the Freudian canon and hence advised women to stop bothering about what is feminine or what is not, and instead overcome their “feelings of inferiority”. The peculiar fascination with sex differences must be regarded as a danger signal and women should forget about these differences and develop their “potentialities as human beings” (ibid 117-118).

1.6 Deviance and social control

“Pathological symbiosis” is here seen as deviancy. According to H. Becker’s original thesis, deviant behaviour should be seen as an expression of power from above, rather than as an act of the individual (1963/1985). Parental deviance as the result of a vague, psychological diagnosis propelled by the alleged and powerful aim of protecting children hence may be interpreted as a form of social control. The central ideas in the new sociology of social control, “contrology”, are heavily inspired by Foucault’s concept of power. It is not produced naturally by the invisible hand of society, but rather is consciously fashioned by the visible hand of definable organizations, groups, and classes (Scull, 1988:686 in E. Goode 1994:134). Social control is coercive, repressive, and far from benign, although it typically appears as a ”velvet glove”. It is ”within the state’s power to manipulate, dominate and constrain that we discover the secrets of social control in the modern age” (Spitzer 1987 in E. Goode 1994:134). Social control is coterminous with state or state like[32] control. Organizations, agencies, or institutions, including social welfare organizations, psychiatrists and psychiatric agencies perform the function of social control on behalf of, or in the service of the state. Media “are involved in controlling through defining and shaping public opinion and influencing how deviants are to be dealt with” (E. Goode 1994:134-135). Media reporting tends to favour a state approach rather than a “family” approach in matters of child protection (P. Klevius 1999).

2. Purpose, Problem and Method
2.1 Purpose and problem

The purpose of the study is a) to elucidate whether “pathological symbiosis” is a familiar and relevant concept for social welfare secretaries, b) to present research on risk and prevention c) to understand the emergence of “pathological symbiosis” in the light of sex-segregated opportunity structures and traditional sex role attitudes affecting main female child psychoanalysts.

Two hypothesises are considered: a) that “pathological symbiosis” is a concept that is familiar and relevant for social workers, b) that the emergence of “pathological symbiosis” can be understood as a result of sex segregation that main female child psychoanalytic contributors to the concept had experienced. Hence the former tries to establish whether the concept is trivial or relevant today, and the latter whether it perhaps could be more connected to sex segregation within child psychiatry than in the best interest of the child. This, however, does not suggest that the connections are exactly the same now and then but rather that the same pattern of sex segregation within which the concept was created still exists and should be further investigated, although it is not possible within the range of this study. The following questions are addressed:

a)      Is the concept of “pathological symbiosis” familiar and relevant for social workers in Stockholm?

b)      Can the emergence of the concept of “pathological symbiosis” be understood as a result of sex segregation?

2.2 Method and outline of the study

Hermeneutics paves the way for an intuition of essence based on pre-understanding. Because the basic idea in Freudian[33] psychoanalysis is the “sexual theory” that ultimately rests on a distinct sex-dichotomy, the material is evaluated due to sex segregation. An additional tool for directing the reading is the comparison of the negatively charged and deviant “pathological symbiosis” with the positively charged “attachment”. Hermeneutical understanding is achieved by repetition of interdependent meaning of the parts and the whole. Conceptualisation is based on critical reflection of the research setting, thus enabling a better understanding of emerging patterns. The hermeneutical circle can be described as a systemized and continuously changing relation between understanding and pre-understanding. Furthermore pre-understanding not only rules what one is prepared to know, but also what one is willing to accept. An inadequate pre-understanding produces misunderstanding, or lack of understanding (J. Lindström 1990:51). Revision of pre-understanding hence enables new meaning.

Although most forms of empirical research need techniques for control, one should be cautious not to make the control aspect foremost. “Horizontal generalization”, for example, only scans the observable surface thus preventing the discovery of essential in depth information as well as contradicting the officially stated purpose of the research (J. Lindström 1990:67). Essential for understanding is the combination of the meaning in the time and context when it emerged, and its counterpart when the hermeneutical interpretation is made (J. Lundequist 1998.13). In accordance with D. L. Altheide & J. M. Johnson’s suggestion of criteria for interpretive validity within ethnographic studies, the following topics are included. My additional remarks in brackets).

The historical contexts (psychoanalysis/sex segregation)
Key individuals (Margaret Mahler and, to a lesser degree, Anna Freud)
Activities (including both private and professional ones)
Temporal order
Hierarchies (as an effect of sex segregation)
Variations (individual contrasts and similarities)
Significant events and their origins and consequences
Members’ perspectives and meanings
Social rules and basic patterns of order

This definition of the situation, its nature, character, origin, and consequences are aimed as a template for the investigator and a framework for the reader (1994:491).

Main guidelines in the hermeneutical process include:

Hermeneutical understanding is achieved by a system of interpretation with its different parts logically connected (P-J. Ödman 1994:86-101). “Pathological symbiosis” is here connected to its psychoanalytic origin, and to its positive counterpart, attachment. Furthermore the system of presentation is guided by a reading focusing on sex segregation and how it can release possible alternative understanding.
The hermeneutical system of interpretation has to be connected to the main object of interpretation (P-J. Ödman 1994:86-101). All interpretations in this study are ultimately connected to ”pathological symbiosis”. The interpretations throughout the study are balanced between deviant (“pathological symbiosis”) and healthy (attachment) aspects.
Due to the hermeneutical interest in increased inter-subjective understanding between people of our time (P-J. Ödman 1994:86-101) some effort has been made to simplify the language of the study by avoiding specialized terminology.

According to D. Glaser, internal consistency of the argumentation is based on conclusions derived from the premises. Results from social sciences as well as other scientific topics can be used (1995:22). Control in hermeneutics is achieved by:

Internal control measures the logic within the system of interpretation.
External control focuses on the object of interpretation. Interpretations and theoretical assumptions are continuously checked against primary data, and in extension refining and modifying the interpretation of primary data and main interpretation (P-J. Ödman 1994:86-101).

The qualitative telephone survey, covering all the districts of social authorities in Stockholm, was conducted with semi-structured questions and completed in 2002. Depending on the answers the interview was directed in accordance with the purpose of the study.

Scanning for textual, oral, and other sources has continuously been made throughout the process. Every finding has been evaluated due to its further use and the actual state of knowledge and understanding[34]. Additional information has been scanned for in indexes, references, footnotes, interviews etc.. When new threads have appeared the process has been repeated in line with the hermeneutical method. Accordingly the progress of the work has determined the variety of, often trivial, means and methods used in the search/understanding process itself. “Pathological symbiosis” is here treated as a child psychiatric concept[35] based on psychoanalytic ideas that were compiled by M. Mahler, who took her inspiration from S. Freud’s daughter Anna Freud. In addition the concept is used in line with the Swedish child protection act LVU and the discussion on symbiosis and attachment in the introduction and background above. Reading and interpretation are limited in accordance to this usage of the concept and its possible connections to sex segregation.

The study is divided in: Background/pre-understanding; a qualitative, semi-structured survey interview; a presentation of risk, prevention and attachment research; a discussion on sex segregation; a presentation of the emergence of symbiosis in the psychoanalytic epistemology and; a hermeneutical presentation of female child psychoanalysts. The findings are developed into a final, main interpretation.

3. “Pathological Symbiosis” in a Social Setting
3.1 Survey among social welfare secretaries in Stockholm

A telephone survey was conducted in September 2002 covering Stockholm’s 18 social districts or “panels of lay assessors”. The procedure was aimed to follow the pattern of a real report over telephone of child abuse/neglect. A social welfare secretary especially familiar with cases involving LVU represents each district in the survey. The name of the district and the social welfare secretary as well as a written description of her/his comments was filed. The survey was not terminated until every district was represented[36].

Semi-structured interviews were based on three basic questions plus an open question regarding possible additional information or remarks. Depending on how the questions were answered, the interviewer directed the interview in accordance with the purpose of the study. Of the respondents all but one were females. The male respondent was the only one who did not recognize the concept and he also doubted the necessity of it. Furthermore it must be acknowledged that many of the respondents seemed reluctant to enlighten the topic.

The following questions were asked:

Are you familiar with the concept of ”pathological symbiosis” in LVU?
Is the concept relevant as a criterion for the use of LVU?
Can you exemplify how the concept is used in LVU cases?
Additional remarks if any?

The main findings out of 18 districts, represented by the first available[37] social welfare secretary specialized in LVU cases, were:

17 districts reported that they were familiar with the concept.
According to 17 of the respondents the concept is relevant in LVU.
The most common family setting to sign “pathological symbiosis” was a single mother and child/children household.
According to one of the respondents “pathological symbiosis” is extremely common whereas another considered it extremely rare although she was informed that it had been used at her district. One respondent did not recognize the concept and did not think it was important.
According to one of the respondents upper-class families had better possibilities to avoid LVU. Re-unification was also more common among these families.

Some expressions describing “pathological symbiosis” used by the respondents follow below. Each number represents a particular district. The extracts are collected from all three questions as well as from offered examples:

“Especially regarding boys who live alone with their mothers” – “too close (Sw. ‘tät’) contact (Sw. ‘kontakt[38]’)”
“The concept is certainly needed” – “probably among all ages”
“More space (Sw. ‘luft’) between parent and child”
“A symbiosis that does not benefit the child” – “anxious about the possibility that the development of the child is prevented” – “always contacts child psychiatric expertise” – “the school reports that the parents prevent the child’s relations (Sw. ‘barns kontakter’)”
“Does not want to release the child” – “Fadime[39] cases”
“Especially single mothers with a son” – “usable as an argument for LVU”
“Mother and child” – “mother who gave the breast to a four year old child”
“Attaches children too closely to themselves – they may themselves have been too closely attached in their own childhood” – “a boy becomes a criminal at an early age”
“A boy – 15 years ago - that slept in his parent’s bed although quite old” (Sw. ‘långt upp i åldern’) – “was not allowed to go to school” – “the parent does not let other adults approach (Sw. ‘närma sig’) the child”
“Mother and child” – “part of a teenage problem” – “during separation” – “mental illness” – “drug abuse”
“Not infants but children 6-8 year old” – “problems with relations to teachers and staff” – “clinging children (Sw. ‘klängiga barn’)” – “blurred borders” – “the parent is not integrated as a person”
“Multi-generational family feud” (the respondent expressed fear about the possibility that her answer might be traced)
“Not pathological but symbiotic” – “a position of dependence”, “mother with mental problems ties an eleven year old child too closely to herself”, “sometimes we use BUP (child- and youth-psychiatric clinic) but often we recognize it by our self or from the school”
“Mother with son or daughter”
“Both parents too close” – “makes it difficult for the pre-school” staff – “longs for mother”
“Very frequent” – “mother with problems of her own” – “poorly talented” – “unable to understand the needs of the child” – “ties the child too tightly to herself” – “children at the age of 6-7” – “regression” – “keeps the child at an earlier age” – “the child does not show up at day care or school” – “the child is sick”
“The child behaves strangely at school” – “does not show up at school” – “the parent has difficulties to interact” – “we suspect the mother’s mental health”
“Psychological abuse” – “the peculiar character of the parents”

3.2 Research on risk and prevention

There are no known Swedish studies on the prediction in childhood of future criminality or deviance targeting solely the effects of  “pathological symbiosis”. But this particular problem can perhaps be indicated in studies covering relations between parent and child. Although most of the research dealing with predictions made on the grounds of family circumstances is a mix of prospective/retrospective studies, the ideal prediction is solely prospective (H. Tham 2001:334). The impossible task of individual prediction is difficult to handle in social policy and even more so in social reality. It would, for example, according to B. Vinnerjung[40], “have been so much easier if the reality of children’s road from an exposed childhood to adulthood had been in accordance with the Social Department’s report Children Today”[41] (2000:69). Child protection is ultimately, and axiomatically based on the belief – or alleged conviction – that separating the child from its parents is always in, if not the best, but the better interest of the child. Unfortunately it seems that empirical scrutiny falsifies the notion that foster care reduces developmental risks compared to growing up in ”insufficient” families of origin. Furthermore it also raises doubts about the prognostic abilities of social authorities (B. Vinnerjung 1996:315). Although several studies have indicated that family- and behavioural problems during up bringing are related to later criminality, researchers stress that these findings are based not on singular indications but on models including several risk factors (H. Tham 2001:338-339). In a study[42] referred to by H. Tham, 90 percent of those at the highest risk did not repeat crimes. Thus background seems to be less important than personal characteristics. Truancy, drug abuse and children on the run are examples of unwanted behaviour that, perhaps, should have called for early intervention[43] (ibid. 340-341). Unfortunately individual predictions are both positively and negatively false. It could then be expected that we are running out of possibilities for more precise predictions on the individual level. Furthermore, individual prediction does not explain crime fluctuation dependent on social groups, countries and historical époques. In conclusion one should not expect that a criminal policy strategy resting on early interventions is a good solution (ibid. 354-355).

Supervision and mother’s self-confidence[44] has been found as related to crimes against property as well as crimes against persons. Mother’s affection and father’s deviance were related to property crimes – although not to personal crimes – (J. McCord 1979:229). According to P. Martens, parents who are the least informed about their children’s whereabouts tend to have juveniles with the highest crime rates. The closer the relationship, the better informed the parents seem to be. Thus, the parents’ possibility to monitor their juveniles is a function of how closely the parents and the juvenile are emotionally and socially attached[45]. Conversely, the more distant the relationship between the parents and the juveniles, the less informed the parents tend to be[46] (P. Martens 1992:147). Although broad social categories may have less predictive value on an individual level, the indications seem clear. Furthermore, according to P. Martens, some classic myths about delinquency and deviant behaviour are challenged. The relationship between the socio-economic status of the family and the juveniles’ participation in crime is weak. Low participation rates also correlates with parents who respond with anger[47] (ibid. 141). This latter observation may be valuable when evaluating “relational problems”, including affected parenting that easily can be misinterpreted as “psychological abuse”. Close social and emotional relationship between the juveniles and the parents, i.e. a high degree of attachment, tends to lower participation rate in various types of crimes. On the other hand most studies show that juveniles with a distant relation tend to participate in criminal acts relatively often (P. Martens 1992:141).

The incompatibilities between the discourse of child protection and the social reality of deviance are well exemplified in a study of grown up boys from Stockholm[48]. Although school variables collected in the sociological – and to some extent also in the socio-psychological part of the study – provided the best basis for prediction of future social adjustment, the sociologists[49], however, never reported such predictions. The results clearly reveal that school difficulties are important indicators of the risk of poor social adjustment in adult age. On the other hand the “classical” sociological variable of social grouping seems to have a limited significance. The psychiatric prognosis – evaluation on condition that no treatment was given in the sequel – had the strongest correlation with social adjustment in adult age (J. Sarnecki & S. Sollenhag 1985:97-98). Interestingly enough a considerable proportion of the individuals, who as adults proved to be well adjusted, came from the group with a fairly poor, psychological prognosis (ibid. 92). In conclusion J. Sarnecki & S. Sollenhag states that: “Precisely the correlation between poor adjustment at school and poor social adjustment in adult age is the very strongest in our material” (ibid. 106). After 30 years of age prosecutions had been brought against 17 percent of the controls, 18 percent of the 222 Stockholm boys, 29 percent of the criminal boys, and 48 percent of the Skå boys. “It should be noted that the differences in proportion of prosecutions between the various groups are greater as regards prosecutions for serious crimes than for crimes punishable by fine” (ibid. 110-111).

In a study carried out on Swedish school children in the mid 1990’s self reported delinquency was negatively related to the parents’ knowing about the youngster’s socialising and whereabouts, doing nice things together with one’s parents and parents being expected to react negatively to truancy. The strongest of these correlations was parental supervision. Immigrant background, parents’ socio-economic status, and broken homes, on the other hand, presented a relatively weak correlation with total delinquency (multiple R = 0.15 – 0.22). The results correspond with Hirschi’s social bond theory and indicate that young people with weak social bonds of various kinds – especially to parents – tend to be more delinquent than those with strong social bonds to their parents. Despite the differences both in time and place these results are strikingly similar to Hirschi’s study in USA in the mid 1960’s (J. Ring 1999:199-212).

3.2.1 Social bond and attachment to parents

A strong parental attachment to consistently disciplined children is the practice in child rearing that appears to matter considerably in criminality and deviance (T. Hirschi, 1995). The relationship between the delinquency of young people and their social situation in the family, school, and peer group domains constitutes the base for T. Hirschi’s social bonding theory. According to the theory the risk for delinquent acts increases as the social bonds tying an individual to mainstream society are weakened. T. Hirschi studied self-reported delinquency among schoolchildren in the USA in the mid 1960’s. His results support strong attachment between parents and children (1974). According to J. C. Garelli the theory of attachment by John Bowlby redeemed the infants their rights to be seen as healthy humans, and, contrary to what everybody asserted, infants were only interested in socializing from birth onwards:

According to Freud and his followers, the infant faces serious problems trying to make out itself from the other, or others. They assert he feels as though the external world did not exist. Margaret Mahler, the champion of this trend of indiscrimination between self and other, even talks about a “phase of normal autism and normal symbiosis” which would last for at least a year; that is why her book is entitled "The Psychological Birth of the Human Infant", as though we humans were doomed to go through two distinct births, a biological birth, whereupon we prove to be dependent, hallucinatory, indiscriminate, autistic, symbiotic, paranoid, schizoid, and so on. It seems as though one were being described a serious psychopathological condition. Under such dire settings, communication with an infant proves impossible, hence socializing with an infant would have to be postponed till he overcomes those so-called early developmental stages and becomes a more or less tractable child. One is amazed at the extraordinary luck we humans posses having been able to make it through the hazards of evolution with such seriously handicapped offspring: mothers in the Pleistocene must have been super-mothers, especially taking into account no Early Stimulation Treatments were available at the time (J. C. Garelli 2001).

J. Bowlby studied children confined to institutions and found them deficient in emotional and personality development. He concludes that maternal deprivation causes deficiencies (1951). Even most of the inferior parents are good for the child because of the continuity[50] they offer (1954). His formal statement of the attachment theory ‘The Nature of the Child's Tie to his Mother’ (1958) was presented for the British Psychoanalytic Society, but was considered controversial because of its anti-psychoanalytic[51] approach. Donald Winnicott: “It was certainly a difficult paper to appreciate without giving away everything that has been fought for by Freud”. Anna Freud concluded: “Dr Bowlby is too valuable a person to get lost to psychoanalysis”. (J. C. Garelli 2001). Hence Anna Freud seems to represent those very people that Bowlby accused for not being able to admit that children are much better off in their bad original homes than in institutions[52]. Although one might suggest the possibility of “too much attachment”, it seems that such a standpoint may turn problematic because it is by necessity heavily influenced by structures and values outside the mother-child dyad, i.e. which criterion should apply?

3.3 Symbiosis in psychoanalytic epistemology

S. Freud never seems to have used the term “symbiosis” to refer to phenomenon associated with psychoanalytic concepts of development (T. M. Horner 1985) in the sense presented here. Sandor Ferenczi, who was the psychoanalytic thinker that, from M. Mahler’s teenage and on, together with A. Aichhorn was the most influential on her development, contributed to this topic already in 1913 by asserting omnipotence as embedded in an original undifferentiated state (ibid.). In the 1920’s Jean Piaget, who focused his research in developmental psychology and genetic epistemology on how knowledge grows, referred to the non-differentiation of self and others in the child’s developmental process (Piaget 1929). Freud’s follower, Otto Rank, used separation-individuation and symbiotic modes of functioning to deal with the “trauma of birth” part of his central thesis in Truth and Reality, published in 1929 (1968). In Escape from Freedom Erich Fromm[53] presents the idea of symbiosis connected to his social psychoanalysis (1941). His description of separation-individuation is, according to T. M. Horner, essentially the same as that later presented by M. Mahler. In 1949 M. Mahler gives the first hint of her evolving theory about symbiosis in a footnote in ‘Clinical studies in benign and malignant cases of childhood psychosis – schizophrenia-like’, American Journal of Orthopsychiatry. Vol 19, p 297, footnotes. The same year, 1949, Therese Benedek published what was perhaps the first use of the concept of ‘symbiosis’ to characterize the early mother-infant unit (1949). This is one year after the “invention” of the “schizophrenogenic mother” (also in a footnote, see footnote 54 below). In 1975 M. Mahler et al published the main work The Psychological Birth of the Human Infant.

A precursor to the idea of symbiotic relationship between mother and child is clearly visible in A. Aichhorn’s method of creating dependency in children and youth (1936). Furthermore most of A. Freud and M. Mahler’s contributions to child psychoanalysis were presented during the period of sexual counter-revolution between the 1930’s and the 1960’s. According to L. Appignanesi & J. Forrester the mid-twentieth century was a special time of emphasis rather on a proper motherhood instead of a penis envy transformed to competition with males (1992:458).

3.4 The emergence of “pathological symbiosis”
3.4.1 Early child psychoanalysts

The history of child psychoanalysis begins with Sigmund Freud’s case[54] of the five-year-old “Little Hans”, published in 1909. However, treatment of delinquent children and youth by the means of psychoanalysis got a bad start for the first female child psychoanalyst, Hermine Hug-Hellmuth, who also was an important influential of Anna Freud. H. Hug-Hellmuth´s analysis/treatment of her first child client, ”Rolf”, seems to have miserably failed.  The boy got a bad history of foster homes and boarding schools and eventually killed and robbed his analyst[55] the same year, 1924, when her ‘New Ways to the Understanding of Youth’ was published (L. Appignanesi & J. Forrester 1992:196-203). More than three decades later Margaret Mahler presents her view on how a too close, “symbiotic” attachment between parent and child causes pathology and delinquency.

3.4.2 “Black Devil” [56] mothering the “frail child”[57]

According to R. Webster, her father entrusted Anna Freud with the “frail child” of the psychoanalytic movement. She then guarded it with all the jealousy and all the fierceness of a mother protecting her own child (1995:402). “From the beginning Anna did not form a close bond with her mother” (J. Bumb 2002) and Freud’s analysis of his daughter was aimed to support her to develop the right “femininity” thus helping her getting married in an appropriate way (R. Webster 1995:409-418). S. Freud’s emphasise on the pre-Oedipal stages in 1918-1922 may be related to this. Anna stated, “I wanted beautiful clothing and a number of children but I considered myself to be too shabby and inconspicuous” (J. Bumb 2002). The family referred to her and her sister as the “beauty and the brains”. According to Anna she never wrote much on female issues within psychoanalysis because she felt that she identified with male case studies. She was then sent, together with her grandmother, to Sicily and other parts of Italy to improve her health[58] – probably depression and anorexia – (J. Bumb 2002) and to make her more “joyful” and “marriageable” (Webster 1995:407-409). “According to Freud’s own theories his analysis of his daughter was an attempt to resolve her problems with her sexuality. Psychoanalytic theory suggested that Anna had become fixated at an essentially infantile stage, and that she had simultaneously identified with the father who had supposedly been the object of her first sexual desires”[59] (ibid. 415).

A. Freud’s special mix of career and psychological motherhood begun in 1923 when she cared and analysed the children of Freud’s neighbours who lived in the same house. She vicariously tried to be a mother for them (from Young-Bruehl[60] 1994, in J. Bumb 2002). “…I have this dependency, this wanting to have something, even leaving my profession aside, in every nook and cranny of my life." According to S. Freud "our symbiosis with an American family, whose children my daughter is bringing up analytically with a firm hand, is growing continually stronger" (Dyer, 1983 in J. Bumb 2002). In Anna Freud: A Biography, E. Young-Bruehl states: “She remained a ‘vestal’ – to use the apt word Marie Bonaparte later chose to signal both Anna Freud’s virginity and her role as the chief keeper of her father’s person and his science, psychoanalysis.” ( in J. Bumb 2002).

In addition to a strong wish for motherhood, and a strategy to create dependent children in the analysis (compare A. Aichhorn above and below), knowing what is best for the child seems to have been the main characteristic of A. Freud’s child psychoanalytic approach, all of which is embedded in a rigidly sex-segregated discourse. Half a century since the first analysis of the Burlingham children A. Freud co-authored Beyond the Best Interest of the Child, mentioned above as the main source for the “children’s need” approach, which also became the view of the Swedish legislator. We are here warned for the “confusion” of “insufficient” sexual identities: “The sexual identities of the parents may be insufficiently resolved so as to create confusion in the child about his own sexual identity.” (A. Goldstein et al 1973:15).

Anna Freud showed a visceral antipathy against Melanie Klein, the foremost child psychoanalyst of the time. According to Alix Strachey, Anna hated M. Klein, the “ultra-sexual Semiramis waiting to be pounced on”, simply on personal grounds (L. Appignanesi & J. Forrester 1992:289) thus supporting a more personal view on the work of A. Freud and its motives as a whole. A. Freud’s influence in the field of child psychoanalysis grew rapidly and “the Hampstead Clinic is sometimes spoken of as Anna Freud's extended family, and that is how it often felt, with all the ambivalence such a statement implies,” one of her staff wrote (J. Bumb 2002).

According to Anna Freud drives play a major role in the psychological development of a child and a teenager (1994). The force of the sexual instinct can be regarded as the energy underlying sexual urges i.e. the “libidinal energy” of the child, meaning the energy of the child’s sexual activities. In the same manner “aggressive energy” underlies the aggressive urges of the child. The flow of this energy, says A. Freud, we have to try to observe in the child if we want to have any chance to guide and influence it (A. Freud 1992:69). She then outlines the child’s fight against its family ties:

On the line from Biological Unity with the Mother to the Adolescent Revolt[61] against parental influence, we expect the normal child to negotiate a large number of libidinal and aggressive substations such as: the symbiotic, autistic, separation-individuation phases (Mahler); the part-object (M. Klein), need-fulfilling, analytic relationship; the stage of object constancy; anal-sadistic ambivalence; the triangular phallic-oedipal relationship; the latency extension of ties to peers, teachers, the community, and impersonal ideals; pre- adolescent regressions; adolescent struggle against infantile ties and search for objects outside the family (1982:63).

Early stages of infantile sexuality, not the puberty, are crucial due to the normal or abnormal development of the child as well as for its capacity to love (A. Freud 1994:116-117). But reversed, this statement would imply that puberty, not early stages of infantile sexuality, should be the crucial, measurable variable, revealing deviance. Thus, instead of focusing on uncertain and quantitatively, immeasurable mystical[62], sexual traits from early childhood – deformed by the hypothetical repression/unconsciousness hypothesis – there may be alternative hypotheses better in accordance with measurable deviance. One can, for example, reverse the separation-individuation thesis of M. Mahler, hence narrowing an attachment approach. According to this, deviance and delinquency are negatively correlated to attachment between parent and child. But contrary to this, A. Freud expects the normal child to develop from the biological unity with the mother to a defense against parental influence. A. Freud’s own personal situation is reflected when she states that:

…parents’ feelings for their children arise from the depth of their inner lives and are based on procreation and pregnancy, on the emotional dependence of the child, and on the unquestioned proprietary rights of the parents. None of these feelings, however, have any significance for the professional. I cannot help seeing it as our task to arouse this type of interest (deeper dependency on their side, or deeper bonds from the side of the adult) in all the people who work with children. Not love, for which there is no real basis, but an insatiable curiosity to learn more about the problems of child development seems to me the appropriate bond which ties the professional workers to the child in their care, irrespective of the fact whether work is located in school, in the hospital, in a social agency, or in the child therapist’s office (1982:298-299).

Although Anna Freud emphasized a limited love approach she does not seem to have considered the balance between the subjective, human and the professional[63]. Moreover, an important, but perhaps also misleading, key to A. Freud’s understanding and interpretation of children lies in “the parent’s bedroom”:

I and my co-workers could demonstrate to them how often their playrooms became stages where sexual and aggressive scenes in the parental bedroom were acted out by the children, and that understanding of this nonverbal communication offered a key to the children’s confusions, distresses, anxieties, unruliness, and uncooperativeness, i.e., to behavior problems which remained inexplicable otherwise (1982:309-310).

Although Beyond the Best Interest of The Child served as an influential guide for those who argued for the removal of the child from their parents, she also strongly emphasized, according to L. Appignanesi & J. Forrester, a child’s need for “unbroken continuity of affectionate and stimulating relationships” (1992:304). In fact, her contribution seems to have rested in a worry about children in temporary foster placement. This aspect of A. Freud’s later thinking seems not to be reflected in the preparatory works of the revised LVU.

3.4.3 An un-analyzable, “sticky libido” “disturbed by motherhood”

Psychological symbiosis is a key concept intimately connected to M. Mahler’s work. Consider, says P. Stepansky, its widespread usage: “To the extent that when mental health workers and psychologically astute laymen characterize relationships of extreme dependency as ‘symbiotic relationships’, and speak of the chronic needs of such people for support and reassurance as ‘symbiotic needs’, they operate within a Mahlerian paradigm.” (P. Stepansky 1988:xvii). M. Mahler took her inspiration directly from Anna Freud, in theory as well as in observational techniques, which she extended to the use of film cameras. But who was M. Mahler?

Expectations on a girl’s development to a woman in a rigidly dichotomized gender world were extremely pronounced in A. Freud and M. Mahler’s upbringing. “Growing up for Margaret was not a happy time, she had a very low self-esteem and was jealous of the praises that Suzanne received from their mother.” (L. Woolf 2002). Margaret obviously did not fulfil the gender expectations of her time, and in an extension she seems to have internalised her childhood experiences in her evaluation of motherhood:

Margaret once overheard her mother say to Suzanne “I have brought you into this world, I suckle you, I love you, I adore you, I live only for you, you are my whole life.” Margaret’s heart being shattered, replied, “And I, I was born to my father.” Margaret later believed that the way her mother treated her was the reason she grew such an interest in paediatrics and psychoanalysis (L. Woolf 2002).

A. Freud and M. Mahler had similar relations to their fathers who supported a “tomboyish” profile while they were young and later on pushed them back into the “womanhood” and “femininity” of the 19th Century. The clash between out-dated femininity and modern intellectuality seems to have severely affected M. Mahler:

Margaret's father supported her and watched while Margaret excelled in Math and Science. Margaret felt she needed to make up where she was lacking, and gave up her feminine self-esteem for an intellectual self-esteem. Crying one day to her father because none of the boys noticed her he replied, “You don't need a man, you are man enough for yourself.” After realizing she would not be a successful sculptor, she decided to enrol in Medical school in January of 1917. Margaret’s father was so proud she was successful in gaining admission. Though he encouraged her to stay away from anything too masculine and to study ophthalmology, because it was “dainty” (L. Woolf).

Already in her teens M. Mahler developed a “deep adolescent friendship” with her high school classmate Alice Balint, another famous theorist of the mother-infant relationship. M. Mahler ended up as a paediatrician on a well-baby clinic in Vienna after having finished her medical and psychoanalytic training (M. J. Buhle 1998:246-248). Her early professional career became strongly influenced by sex segregation and a demand to fulfill her femininity, and especially her “motherhood”:

von Pirquet’s appreciation of my research skills did little to mitigate his absolute horror at the prospect of having any woman in a position of authority. Thus, when I later requested a promotion from ”apprentice” {Hilfärztin) to ”assistant” paediatrician, he replied, ”I will never have a woman as an assistant. You are very smart, and I like you very much, but if one is a woman, and especially if one looks like you, one should marry and have children.” The remark about the desirability of a woman who ”looked like me”, marrying instead of pursuing a profession, was repeated on more than one occasion. I recall, as well, von Pirquet’s comment the first day I donned glasses at the clinic. Inspecting me carefully, he remarked: “Do me a favour. Put those glasses in your pocket,” by which he conveyed the clear meaning that he couldn’t stand them on my face! This disparaging estimation notwithstanding, I idealized von Pirquet and regressed to the point of being well nigh ”in love” with him. (M. Mahler 1988:45).

August Aichhorn, M. Mahler’s tutor and most powerful influential on her “formative years”, was “a mysterious man who lived a strange and charmed life with close connections to the underworld[64] of Vienna” (M. Mahler 1988:51-54). He analyzed her when the therapy with Helene Deutsch miserably failed (see below). According to P. Stepansky, A. Aichhorn also had a “personal relationship” with M. Mahler who was in her early twenties back then. These topics were obviously still too difficult to face when M. Mahler, at the age of 87, was preparing her autobiography (1988:xxxiv). But regarding symbiosis A. Aichhorn’s concept “dependency relationship” was especially important for M. Mahler:

Aichhorn used dependency relationship to ”show” that the child had chosen his delinquent life-style on the basis of past frustrations, abuse, or misunderstandings, but that this life-style was not appropriate to current circumstances. “He was a master at drawing the unconscious motivation out of a child’s recital of circumstance and happenstance and then confronting the child with the underlying reason for his delinquency… These counselling strategies ushered in the second stage of treatment in which Aichhorn undertook to make the child, in his own words, ”as neurotic as he can be made” in order to render him analysable (M. Mahler 1988:51-53).

According to S. Freud the essence of the analytic profession is feminine and the psychoanalyst “a woman in love” (L. Appignanesi & J. Forrester 1992:189). But psychoanalytically formalized sex and sex segregation also seem to have been troublesome components in the lives of female psychoanalysts struggling under a variety of assumed, but irreconcilable femininities and professional expectations. How sex segregation was experienced back then is perhaps best illustrated by Helene Deutsch in Psychology of Women: “She passively awaits fecundation: her life is fully active and rooted in reality only when she becomes a mother. …This speculation, which is based on my own experience, can perhaps be confirmed by a more objective observation: no human being has great a sense of reality as a mother.” According to H. Deutsch “the most miserable feminine type in existence” is a woman who is “disturbed by motherhood” and who “protects herself from the development of feminine qualities” (1944:140-142). H. Deutsch’s emphasise on motherhood has its modern child psychoanalytic counterpart in Daniel N. Stern’s[65] “motherhood constellation” (1995). This stays in sharp contrast with the striking lack of motherhood in pre-historic records (R. Tannahill 1992:36-37).

Because of the above it seems less surprising that M. Mahler’s career within the psychoanalytic movement was initiated by a painful clash with H. Deutsch, who, encouraged by Ferenczi, became her first training analyst. However, after 14 months of constant cancellations H. Deutsch insisted that M. Mahler was “un-analysable” (L. Woolf 2002). According to H. Deutsch, M. Mahler-Schoenberger[66] had a “sticky libido” (M. Mahler 1988:60). Although they apparently did not cope well with each other they also shared some similarities. H. Deutsch’s main “love affair” throughout her life was her father, whereas her mother’s role mainly seems to have been to watch guard Helene’s “femininity” thus causing an early rebellion (L. Appignanesi & J. Forrester 1992:307-328). But unlike M. Mahler and A. Freud, H. Deutsch seems to have emphasized the fulfilment of femininity through real motherhood.

The fact that M.Mahler’s major works are published after her menopause may be considered when evaluating the background of the concept of ”pathological symbiosis” and its connection to her interpretation of “motherhood” and “femininity”. “Margaret loved working with children’s clinical studies on childhood psychosis, it was her passion. She loved the way the children gave her all of their attention and enjoyed working with her as well” (L. Woolf 2002). Her own description is revealing:

Paediatrics, I should perhaps explain, represented a compromise of sorts: it would enable me to be what my father was, while simultaneously accommodating my desire perhaps my outstanding “feminine” trait to work with children. At the time, the desire to become a baby doctor, and thereupon to be a practicing physician like my father coexisted with the equity strong desire to become a psychoanalyst like Ferenczi, the warm father figure I had encountered in the Kovacs household (M. Mahler 1988:23-24).

Like most psychoanalysts, M. Mahler’s theoretical method relays on the use of “normal development” as a reference for the abnormal. In a fast changing world such an approach does not, neither however, necessarily takes enough into account an all time ongoing change in human behaviour nor does it allow for historical flexibility in human societies. Hence the “normal” may in fact rather be interpreted as traces of the past, and as such of limited value in assessing the development of contemporary children. On top of this comes the fact that the scientific basis for M. Mahler’s research seems weak. It is difficult to explain, say M. Mahler et al, how the self-object-representations of the symbiotic phase develop into a self-representation  (1984:244). The results follow from a complicated process of conclusions based on rules that are not clearly established. This is especially true for psychoanalytic research (ibid. 272). An additional problem is hinted at when M. Mahler et al, “half-way through the examination”, decided not to include those children (25 percent) who did not fit into the categories created by the team (ibid. 282). A. Freud taught us, say M. Mahler et al, that children’s playing with their mothers from the age of seven months is not the result of altruistic behaviour[67]. We think the purpose is to discriminate the child’s view on its body from that of the object (M. Mahler et al 1984:245). Briefly, says M. Mahler, “one could summarize my hypothesis as follows: whereas in primary autism there is a de-animated frozen wall between the subject and the human object, in symbiotic psychosis, on the other hand, there is fusion, melting, and lack of differentiation between the self and the no self” (1979:5). This view constituted a considerable brake to traditional psychoanalysis and places the parent in the position of being potentially accused for treating the child in a deviant way. M. Mahler describes the theoretical introduction of the parent (mother) in the realm of the child’s “mental apparatus”:

The whole idea of the mother-infant dual unity, for example, originates in their (Ferenczi[68], Herman, Bak, Benedek) theoretical and clinical perspectives. This developmental viewpoint did not gain expression in the German or Viennese psychoanalytic literature of the time. It is not even found in the later work of Anna Freud. At her Hampstead Clinic, the mother-child pairing was surely recognized, but the child was evaluated separately. “Leave the mother in the waiting room; she is tired,” the Hampstead analysts would say. Anna Freud and her collaborators were concerned almost exclusively with the intra-psychic, which they believed to be the only proper domain of psychoanalysis. Indeed, the intra- psychic is the main thing, but as I have undertaken to show over a lifetime of research and writing, the intra-psychic only evolves out of the differentiation from the individually undifferentiated matrix of mother and child. At the Hampstead Clinic during the 1930’s and forties the clinic analysts had to take great pains to differentiate their position from that of both Melanie Klein and D. W. Winnicott. It was Winnicott it will be recalled, who claimed that there is no such thing as a baby without a mother (M. Mahler 1988:16).

M. Mahler’s method in practical use is described in a paper from 1977 concerning the assessment of narcissistic and borderline personalities in the boy Sy. Two main characteristics in the assessment are recognizable: 1) strong structural expectations and b) “biologism” (constitution) as an alternative explanation when negative expectations are not fulfilled. At first Sy is assembled into the theoretical framework:

Sy’s sub phase developmental history was characterized by prolongation up to his twentieth month of the nocturnal “child-lover-at-the-breast” symbiosis. This, without more than a nominal experiencing of the practicing and rapprochement sub phases of separation-individuation, was overlapped by and continued as a bizarrely frank oedipal relation with his mother and later with his father (M. Mahler1979:201).

In the next step, Sy’s mother is accused for causing borderline in her son:

From the time he weaned himself and walked, Sy was treated by the mother as her “man,” with reciprocal behaviour on his part. It is a demonstration in statu nascendi and step by step of what Kernberg (1967) describes as the genetic-dynamic analysis of the borderline personality’s oedipus complex. He says: “What is characteristic of the borderline personality organization… is a specific condensation between pregenital and genital conflicts, and a premature development of oedipal conflicts …” (p. 678 in M. Mahler1979:201-202).

However, because of “lack of space”, all the failures of Sy’s poor ego function cannot be elaborated. One example is given, though:

We could follow, in the second part of Sy’s third as well as in his fourth, fifth, and sixth years, the vicissitudes of the failure of the ego’s function of normal repression. There were many instances of this failure, but for lack of space we cannot elaborate on them. An example might suffice: Sy remembered minute details about the Centre, which the other children had completely repressed. These details were syncretically retained by his ego’s pathological memory function (SPI:11 in M. Mahler 1979:201-202). 

There are no hints given, except of this fairly poor one, due to the disastrous powers assumed to reside in Sy. M. Mahler and her research team, however, are deeply concerned: “Sy’s intra-psychic conflicts can be only guessed at, of course, and we would like to get Sy into analysis, but both parents are opposed to it” (M. Mahler1979:201-202). Quite contrary to M. Mahler’s prediction it all seemed to get a happy end – except for the teachers’ un-explained irritation with the family:

Follow-up home and school interviews of Sy in his eleventh year described him as faring much better than we would have predicted. His academic achievement in an honors class in a local public school is excellent and he is fairly popular with his classmates. The teachers, however, could not suppress their irritation with Sy and his family (M. Mahler1979:201-202)..

The explanation to this incomprehensible success M. Mahler finds in Sy’s biological constitution:

We believe that the positive qualities that saved Sy from psychosis were his excellent endowment, for example, the way in which he made up for his slow locomotor development by becoming extremely proficient in gymnastics (his favourite activity was acrobatics) (M. Mahler 1979:201-202).

A similar reference to biological factors, however, is completely absent in the case of “another girl” who, during the last couple of days before she arrived at the Centre, had been unable to pass her stool. According to M. Mahler et al, the 29-month-old girl’s behaviour was extraordinary because she liked to play with water in the children’s playroom, and the most plausible explanation to this was a “compulsion”. When she sat on the toilet the “observer” reported that she looked worried and asked not to let the mother in. The “observer” asked her to tell more about it[69]. Then, we are informed, through the “observer”, that the girl said: “Mother hurts me” (this happened during the most intense “the battered child”-debate). But when the pain increased the girl asked for her mother, who then read a book for her until she was released and happy. According to M. Mahler et al, the stool was passed when the girl saw a picture of a foul and shortly after she had pointed to a picture in the book saying: “Dad has a pig in his belly”. This has to be explained as the result of a poor mother relation. Later the girl did very well at school and her social development was good (1984:99-103). This case is of special interest because of its close resemblance with the private life of M. Mahler herself. As noted above, she suffered from a poor connection to her mother and in 1921 she had severe stomach pains and attacks that horrified her circle of friends. She was diagnosed with Heirshsprung’s disease, a congenital disorder that makes one unable to relax and permit the passage of stool. After medical treatment the problem ended. Considering the psychoanalytic interest in anal problems the connections above may not be surprising.

3.4.4 Main characteristics of pioneering child psychoanalysts

M. Mahler, who was childless[70], intellectually relied on S. Freud and his childless daughter Anna. She made her contributions to child psychoanalysis after her menopause and mainly in the especially sex-segregated period from the 1940´s to the 1960´s[71]. A comparison reveals that the similarities between A. Freud and M. Mahler stay in sharp contrast to the view represented by Melanie Klein, the mother of three and a female child psychoanalyst of the less sex-segregated 1920’s. M. Klein was considered a dissident in the psychoanalytic movement because of her early insertion of the Oedipus complex and her suggestion of a primary femininity phase for both sexes (L. Appignanesi & J. Forrester 1992:451-452). Having in mind that M. Mahler’s “pathological symbiosis” concerns mothers, and that “motherhood” is intimately connected to “femininity”, two opposite views on mother/child relations emerge. Whereas the Kleinian view emphasizes the child’s destructive and even violent tendencies towards the mother, the view of A. Freud/M. Mahler recognizes the mother as the main source of pathology.

M. Klein compared free associations with the play of a child and, like S. Freud himself, analysed her own children (Webster 1995:431-432). But in contrast to the view that small children have a weak and unformed superego, she considered the superego of a young child as monstrous, because of early – even before birth – persecutory experiences and fantasies. The superego, hence, should not be strengthened, as A. Freud advocated, but rather be modified to help its integration (L. Woolf 2002). Thus M. Klein’s mother appears to be a resource rather than a threat. Where M. Mahler is searching for a possible “parasitic parent”, M. Klein sees “good enough mothers”. Whereas M. Mahler emphasizes the victimization of the child who has not been properly released from the mother, M. Klein’s approach includes an inherent “badness” in the child in accordance with S. Freud’s own theories. In M. Mahler’s theory the idyllic Eden in the form of the mother/child-symbiosis has to be broken up for the survival of the child, whereas M. Klein’s children already from the beginning were basically paranoid. And whereas S. Freud introduced the super-ego at the age of five, M. Klein inserts it at the age of five month (M. Klein et al 1995:29-35). M. Klein, contrary to A. Freud and M. Mahler, remembered her childhood as mostly serene and happy. She was tremendously impressed and stimulated by her father's intellectual achievements and he was always ready to answer her many questions. M. Klein had a good relation to her mother. Opposite A. Freud and M. Mahler she did not cope well with S. Ferenczi[72] (H. Segal 2003).

In contrast to M. Klein, but in accordance with M. Mahler, A. Freud traces the threats against the child’s healthy development to its mother. The emerging picture is a sensitive, vulnerable being, incapable of adaptation to certain of its mother’s behaviour. Unexplained symptoms are interpreted as psychological:

So far as they (the earliest disorders) have no purely organic cause, they can be traced to interaction of inborn modes of functioning with the mother’s handling of these given potentialities, i.e., her more or less skilful or insensitive, well- or ill-timed response to the infants needs; or they can be traced to the infants high sensitivity to the mother’s emotional states, her anxieties, her moods, her predilections, and her avoidances. Un-pleasure or distress due to either cause can find discharge only in two manners: either through crying, or by way of physical pathways within the somatic areas mentioned above” (A. Freud 1982:19).

Apart from the fact that the above seems more like a simple and quite obvious qualitative evaluation of different methods of parenting wrapped into the mystique of something[73] “discharged through somatic pathways”, a comparison with the view of M. Klein is striking. M. Klein believed that in the play young children “ceaselessly imagined how they might fellate or castrate their fathers, defile or attack their mother’s breast, or imaging or recalling their parents copulating (R. Webster 1995:431-432). But according to A. Freud: “Where a mother, for whatever reason, is unable to give adequate comfort to her infant, this may have a lasting effect on this individual’s own capacity to cope with even normal amounts of un-pleasure, pain, and anxiety, i.e., on his frustration tolerance.” (1982:21). Furthermore, although kinship and other family ties may be the more important the older the child gets because of a widening and more complex life-sphere and a corresponding need of a closer and more sophisticated attachment A. Freud’s following statement reveals a quite limited picture of “the parental task” seemingly utterly devoid of thoughts on continuity, especially over generations:

With the blood tie wholly ignored at this age, he recognizes as his parents the adults who fulfil the parental task in the psychological sense, i.e., who serve his growth by day-to-day interchange of continuous care, affection, and stimulating involvement. As the law stands today children can be forced away from psychological parents, to whom they are deeply attached and under whose guardianship they prosper, and with continuity broken, be made to adapt to biological parents with whom no ties are in existence. It is alleged by some people that return to the biological family is truly in the “best interest” of the child, who thereby will be spared an identity crisis in adolescence. The truth is that in adolescence most children undergo what may be called a crisis of identity when they have the difficult task to grow beyond the parents of their childhood… (A. Freud 1982:302-305).

In conclusion the above reveals a pronounced hostility between childless female child psychoanalysts and female psychoanalyst who had children of their own (A. Freud vs. M. Klein and M. Mahler vs. H. Deutsch). Main characteristics of female child psychoanalysts, as reported above, dichotomised for and against the parent (mother):

In defense of the child[74]                                  In defense of the “good enough mother”

Anna Freud 1895-1982

Margaret Schönberg-Mahler 1897-1985             Melanie Klein 1882-1960                    

Poor daughter/mother-relation
Good relation with her mother

“Tomboyish” childhood encouraged by their fathers. Father’s favourite child. Intellectually encouraged by their fathers. Later encouraged to watch guard their femininity.
Although her father was more interested in her sister, Melanie was impressed by his intellectual skills and took much inspiration from him.

Severe problem with “femininity”, outsider at home, no (A. Freud) or late (M. Mahler at 39) marriage, no children of their own
Serene and happy childhood, early marriage (at 21), children of her own (at 22, 25, 32)

Suggesting a more powerful woman than conventional analysts

Followed Freud’s view on sex segregation, e.g. in  the form of the Oedipus complex
A dissident against Freud’s male favouring sex-segregatation

Obsessed in observing and dealing with children of others

Anna Freud was “vicariously” trying to be a mother.
Analysed children of her own

Met and admired Sandor Ferenczi
Not satisfied with the results of her analysis with Sandor Ferenczi[75]

Most important works in the “feminised” and “mother-centred” era. Supported Freud’s patriarchal view on mother- and womanhood
Most important works in the de-sex-segregated era of the 1920’s and 1930’s.

Strong influence from A. Aichhorn and his method of creating dependency. M. Mahler was in love with him during her analysis.
Not influenced by A. Aichhorn

4. Results and Main Interpretation

The hypothesis a) that “pathological symbiosis” is a concept that is familiar and relevant for social workers, is supported by the survey. Only one (the only male in the sample) out of 18 social welfare secretaries reported that he did not think the concept was relevant. This may be entirely random but may also indicate the overall sex segregation discussed above. A bigger sample in a similar survey focusing on sex segregation could confirm or dismiss a possible connection. Further research tracing “pathological symbiosis” in court rulings and their enclosed reports could confirm or dismiss its judicial importance. Similarly we need further research on how “pathological symbiosis” is used as a means for social secretaries to accomplish a desired outcome in LVU cases. According to research on risk and prevention attachment between parents and children seems to be important for avoiding deviance. Obviously we need not to hinder but rather strengthen attachment between parent and child in a time with loosening kinship-parent-child ties.

The hypothesis b) that the emergence of “pathological symbiosis” can be understood as a result of sex segregation that main female child psychoanalysts had experienced is also supported. The information gathered above reveals a basic concern about femininity and motherhood in the lives and works of A. Freud and M. Mahler. Not only as opportunity structures, fostered in-group feelings, sex stereotypes and traditional sex role attitudes, but also, and perhaps more treacherously, as a burdensome, and not necessarily benign cultural heritage. When shared similarities between A. Freud and M. Mahler are summarized and contrasted with M. Klein above it should be noted that all of them, of course, shared a general female experience of occupational sex segregation. The fact that childless female psychoanalysts are more profiled in defence of the child than the mother psychoanalyst may support the hypothesis that this is connected to opportunity structures based on (lack of) motherhood rather than occupational opportunity structures.


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Stern. D. N. (1995): The Motherhood Constellation - A Unified View of Parent-Infant Psychotherapy. New York: Basic Books.

Sulloway, F. J. (1979): Freud, Biologist of the Mind – Beyond the Psychoanalytic Legend. New York: Basic Book Inc., Publishers.

Sundberg, J. W. F. (1995): The Trip to Nowhere. Stockholm: The Stockholm Institute for Public and International Law.

Sylwander-Nordenskjöld, L. (2002-08-26): Telephone interview.

Tannahill, R. (1992): Sex in History. Scarborough: Scarborough House Publishers.

Tham, H. (2001): Tidiga ingripanden som kriminalpolitisk strategi (Early Interventions as a Strategy for Criminal Policy), in Den Svenska Ungdomsbrottsligheten  (The Swedish Youth Criminality), (eds. F. Estrada & J. Flyghed). Stockholm: Studentlitteratur.

Tuohela, K. (2002): Modernin naisen muotokuvia (Portraits of Modern Women), in Modernin lumo ja pelko (eds. K. Immonen, R. Hapuli, M. Leskelä & K. Vehkalahti). Helsinki: Suomalaisen Kirjallisuuden Seura.

Vinnerjung, B. (1996): Fosterbarn som vuxna (Foster Children as Grown Ups)  Stockholm: Liber.

Vinnerjung, B. (2000): Children Today. Stockholm: Report from the Social Department.

Vinterhed, K., Börjeson, B., Cederström, A., Fredin, E., Hessle, M. & Hessle, S. (1981): Barn i kris en bok om barn och separation (Children in Crisis – A book about children and separation). Stockholm: Almqvist & Wiksell Förlag AB.

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E-mail correspondence with C. Gynnå, on the Department of Health and Social Affairs, who wrote the proposal 1989/90:28. The mails are in reversed order with original text in Swedish and my English translation in brackets..

E-mail from Christina Gynnå 2002-10-28

Jag upprepar: "Jag har redan svarat att jag inte kan erinra mig resonemangen kring propositionen. Vill också påpeka att en proposition inte är resultatet av en enskild tjänstemans skrivningar utan bygger på utredningsmaterial och remissvar."

Du är ute på helt fel spår om du har för avsikt att tillskriva mig enskilda formuleringar. Du kan inte ens vara säker på att det är jag som skrivit specialmotiveringen, än mindre att det är jag som ligger bakom att ta med det exempel du hakat upp dig på. Du kan kontakta övriga medförfattare: och se om de kan erinra sig frågan. Du kan även försöka med övriga chefer, inte minst chefen för dåvarande rättssekretariatet som var ansvarig för propositionen Vem det var kan jag dessvärre inte erinra mig, men det bör du enklet kunna ta reda på själv. Tacksam om du vill sluta kontakta mig. Jag har inget mer att tillägga i frågan.
Christina Gynnå

(”I repeat: I have already answered that i am unable to recall the reasoning regarding the proposal. I also want to point out that a proposal is not the result of a single public servant but rests on reports and the answers on the parliamentary considerations. “ You are totally on the wrong track if your purpose is to ascribe me with individual wordings. You cannot even be sure that I have written the explanatory statement, and even less so, that I am the one responsible for the example you have got hung up on.)

(You can contact other co-authors and ask if they can recall the question. You can also try with other heads,bnot the least the head of the contemporary secretariat of justice who was responsible for the proposal)

(I am afraid I cannot recall who it was but that you can solve easily by yourself.)

(I would appreciate if you stop contacting me. I do not have anything to add in this question.)

E-mail from Christina Gynnå (Department of Social Affairs) 2002-10-11

Jag kan inte erinra mig detta. Som en generell regel gäller att när lagstiftaren lämnar sina förslag grundar han det på det betänkande som remissbehandlats och på remissinstansernas yttranden över betänkandet. På sidan 64 i propen framgår att vissa remissinsatnser nämnde detta. Föreslår därför att du vänder dig till socialdepartementets diarium och går igenom remissinstansernas yttranden.

Hälsningar/Christina Gynnå

(I cannot recall this. As a general rule applies that when the legislator hands over proposals they are based on reports that have been read and son the basis of the opinions from the bodies to which the proposed measure was submitted. On page 64 in he proposal it may be concluded that certain bodies mentioned this. I therefore propose that you turn to the diary of the Social Department and go through the returned opinions of the bodies to which the proposal was distributed.)

(Regards/Christina Gynnå)

E-mail from P. Klevius to C. Gynnå 2002-10-11

Mitt på sidan 108 i prop 1989/90:28 står det uttryckligen att med uttrycket "annat förhållande i hemmet" avses bl a "sjuklig symbios"! Min undran gäller hur/varför detta skrevs in och på vilka grunder (referenser/forskare e d)?
Samma text återfinns i socialtjänstens handböcker typ Socialtjänstlagarna!
  mvh Peter Klevius

(Halfway down on page 108 in the proposal 1989/90:28 it is expressly stated that the expression “some other condition in the home” bear reference to e.g. “pathological symbiosis”! I wonder how/why this was written and on which grounds (references/researchers etc.)?

Regards Peter Klevius)

E-mail from C. Gynnå to P. Klevius 2002-10-10

Hej! Jag hjälper dig gärna i den mån jag kan. Som du förstår så kan jag inte avsätta hur mycket tid som helst till detta; jag arbetar (mer än) heltid med andra arbetsuppgifter.

(Hello! I willingly help you as much as I can. As you may understand I cannot dispose of too much time on this, I work (more than) full-time with other duties.)

Nu till dina frågor; mina kommentarer i fetstil:
(Now to the questions; my comments in bold)
1) 'begreppet "sjuklig symbios" som ett rekvisit för tvångsseparation'. Jag förstår inte frågan. Rekvisiten i lagen (i de s.k. miljöfallen) är misshandel, otillbörligt utnyttjande, brister i omsorgen eller ngt annat förhållande i hemmet. Vad som avses utvecklas närmare på sidorna 64-65. Där nämns inte "sjuklig symbios". Den enda hänvisning jag hittat till begreppet "sjuklig symbios" är i redovisningen av remissinstansernas yttrande (sid. 64), där en del instanser uttryckt farhågor att vissa relationsstörningar som hänger samman med föräldrarnas psykiska svårigheter inte kommer att omfattas av den föreslagna lagtexten. Bland de exempel som dessa remissinstanser nämner finns att föräldern inte knyter an till barnet, att föräldern avvisar barnet el att föräldern knyter barnet till sig i en sjuklig symbios. Som framgår under avsnittet Överväganden finns dessa exempel inte preciserade i resonemanget om förutsättningarna för tvångsvård.

[(1) ’the concept ”pathological symbiosis” as a criterion for compulsory care’. I do not understand the question. The criterions in the act (what is called the environmental cases) are abuse, exploitation, insufficient care or some other condition in the home. What is referred to is more narrowly expounded on pp 64-65. “Pathological symbiosis” is not mentioned here. The only reference to “pathological symbiosis” that I have found is in the account of the opinions of the bodies to which the proposal was distributed (p 64), where some bodies have expressed apprehension as to the fact that certain relational disturbances, which have to do with psychic difficulties are not included in the proposed text of the act. Among the examples mentioned by these bodies is that the parent does not attach to the child, that the parent rejects the child or that the parent attaches to the child in a pathological symbiosis. From what may be concluded of the part Considerations these examples are not specified in the reasoning about the conditions for compulsory care.]

2)  Vet du något om huruvida detta diskuterades/debatterades i riksdagsbehandlingen, t ex i utskott o d? Några namn? Det bästa är att du söker upp riksdagsbetänkandet. Eftersom "sjuklig symbios" inte är ett rekvisit för omhändertagande, skulle jag tro att det inte debatterades i riksdagen, men det är bäst att du går igenom betänkandet.

[2)  Do you know anything about whether this was discussed/debated in the Parliamentary hearing, e.g. in committees etc.? Any names? The best thing to do is that you search for the parliamentary report. Because “pathological symbiosis” is not a criterion for compulsory care, I would believe that it was not debated in the parliament, but it would be best if you go through the report.]

Hälsningar/Christina Gynnå
Regards/Christina Gynnå

Appendix 2

Collection of comments from others than C. Gynnå involved in the writing of the proposal:

Sven Hulterström (Minister of Health and Social Affairs at the time when the proposal 1989/90:28 was written): Cannot recall the concept. Karl-Ingvar Rundqvist: Cannot recall the concept.

Christina Bergenstrand: Does not recall anything about ”pathological symbiosis”. Besides, her main focus was judicial.

Göran Ewerlöf: Does not think there exist any particular basis for this. We clearly apprehended it as belonging to child psychiatry. There where no researchers or references involved.


[1] There are, of course, also similar structures that men are, at least partly, isolated from, e.g. regarding children etc., but generally speaking males have had better access via up-bringing to such sectors as technology and private economy etc., i.e. jobs in the developing and dynamic sphere.

[2] This could be described as reactionary tendencies against a world that is changing “too fast” (P. Klevius 2000).

[3] In research on the judicial processing of drug-related crimes, the term control damage has come to play a major role. In the view of Skjorten, we should now also look more closely at potential control damage in the field of domestic violence and sexual abuse (Skjorten, 1997.12). Here I propose the extension of the term also to cover psychological abuse, e.g. “pathological symbiosis”.

[4] The author believes that because we cannot ever reach the target of fully “understanding children’s situation” we cannot either risk their lives by unsure means of protection against a “possible future risk” (as stated in LVU § 2) based on doubtful, psychological trends.

[5] Thie concept is not mentioned in the text of the act LVU § 2 but falls under “…some other condition in the home …” (which is mentioned in the text), and is then hidden in the preparatory works where these “other conditions” are exemplified (Government’s Bill 1989/90:28 p 108). Because most Swedes, including many lawyers, do not always read the preparatory works that carefully, if at all, one is obliged to seriously doubt the intention with this arrangement, especially when we do know that “…some other conditions in the home…” had a totally different content before the act was revised (SOU 1986/20:304).

[6] LVU is supposed to protect the child exactly on the ground that the child itself cannot do it or understand it.

[7] Technically the Swedish system is now, after some controversies in the 80s, quite waterproof and gives, formally, all the necessary legal possibilities for parents to appeal against decisions of the bureaucrats and those of the courts. The problem is the non-specified concept "in the best interest of the child", which also could be named a "general clause” (slogan) without content (P. Klevius 1996).

[8] A possible explanation might include the fact that Sweden has had a long and stable political climate with a steady and comparably high level of state funding, in which the public bureaucracy has been able to grow and intertwine with politics, thus becoming an ideological/political factor of its own (P. Klevius.1996). Furthermore public social work is a sector where traditional (out-dated) female sex-roles (sex segregation) are more common (P. Klevius 1996, Socialstyrelsen 2004). These trends seem to support a transition of women to the public sector without too much altering of traditional sex-roles (i.e. a continuing of sex segregation in choice of occupation).

[9] The Swedish equivalent ‘otillbörligt utnyttjande’ mainly indicates ‘sexual abuse’, whereas ‘exploitation’, as it appears in the UN Convention on the Right of the Child, has a broader meaning (child labor, trafficking etc). 

[10] These concepts are not visible in the text of the act but outlined and exemplified in the preparatory works.

[11] Swedish Constitution, chap. 1, section 9

[12] Institutionalized homes for care have become an ever-increasing economic factor in LVU cases. There also seem to be a trend from foster parenting towards institutions, which is quite self-evident having in mind the manifold fees that then are accessible. Because Sweden has one of the highest rates of psychologists/trained social and child workers in the population  (most of them females) these transitions are quite understandable  In addition there have been many reports of bad caring quality but no real improvement seems to have evolved.

[13] Beyond the Best Interest of the Child (1973).

[14] SFS Act no: 1990:52, promulgated 1990-03-08

[15] C. Gynnå first denies and then asks the researcher to stop bothering her: ”I repeat: I have already answered that i am unable to recall the reasoning regarding the proposal. I also want to point out that a proposal is not the result of a single public servant but rests on reports and the answers on the parliamentary considerations. “ You are totally on the wrong track if your purpose is to ascribe me with individual wordings. You cannot even be sure that I have written the explanatory statement, and even less so, that I am the one responsible for the example you have got hung up on. “ (C. Gynnå 2002, also see enclosed appendix on e-mail correspondence and a summary of results from contacts made on the basis of it.)

[16] Sven Hulterström was contacted by the author but did not recall the concept (see Appendix 2).

[17] BRIS:  the word “symbiosis” is mentioned once in an enumeration of destructive relations (BRIS 1987). Botkyrka Kommun (Botkyrka County): three words in a similar context are mentioned: “too strong symbiosis” (Botkyrka Kommun 1987).

[18] Although LVU refers to compulsory care this is not mentioned in the title. This is probably due to a general ideological tendency in the 70’s that tried to avoid measures of coercion, or at least down-play its role. Care by consent, however, is regulated in SOL (The Social Service Act).

[19] Sven Hessle has a professional history tracing back to Barnbyn Skå, which was one of the most important Swedish sites for psychosocial experimental work in the 60’s and 70’s. He has for a long period of time lectured his knowledge to students and researchers in psychosocial work at the University of Stockholm.

[20] Has been sold in many Finnish editions but has never been published in Sweden (Eva Aminoff:  Lapsen parhaaksi, (In the Best Interest of the Child). Published by WSOY Helsinki 1996)

[21] According to the preparatory works of SOL (Social Service Act) “subjective information” is allowed in the report (C. Norström & A. Thunved1991:105).

[22] Maciej Zaremba is a Swedish journalist, who made the world aware of the connections between compulsory sterilizations in Sweden 1936-1976 and the ruling Social Democratic party.

[23] While the foster mother was on vacation on the Maldives and the foster father on an unknown destination, another foster boy sexually abused Daniel. This behavior had been previously reported to the social authorities without any effect (M. Sigström). Compare also the case of a girl placed in a foster home and sexually abused there by her foster father. When she took his sperm to the school, the nurse poured it in the sink and asked her to stop these accusations against her foster father. “This is already investigated”. A previous incident of sexual abuse had been reported by the girl to the social authorities but had not given any result. (Klevius 1999:35-36).

[24] Signed by chairman Ingrid Lindahl (s = social democrat).

[25] This text was reported by the social workers, to the Panel of Lay Assessors for the Opinion of the Press, which took as its stance that the author had a good understanding and was well informed about the case. Furthermore the panel noted that the social workers had not responded to considerably many of the grave accusations out lined in the article.

[26] Compare “curling parents”, the popular concept of today.

[27] In 1939 M. Mahler met with Benjamin Spock, famous for The Common Sense Book of Baby and Child Care published in 1946 (later Baby and Child Care).

[28]  Despite a considerable body of ”evolutionary” speculations there seem to be only two distinct facts to rely on in sexual reproduction: heterosexual attraction (HSA, for example what makes: a fish deliver his sperms on top of a heap of roe; a bee to carry pollen to the pistil etc.) and biological kin recognition/altruism. These, however, are almost extinct in the discourse of today. Both Freud (because of a lack of biological understanding, e.g. his Lamarckianism) and Butler (because of an entirely cultural approach) seem to have neglected them. Recognizing HSA would make controversies about sexual identity, homo-sexuality etc. less controversial (also compare L. Irigaray 1985).

[29] Consequently a relevant question to J. Butler (and all feminists) might be: Why do you call yourself a feminist?

[30] The criminologist Cesare Lombroso who believed in ”the born criminal” influenced Laura Marholm’s view on femininity (S. Brantly 1991:54). This is not surprising when considering the abundance of biological explanations in the late 19th century. Although Laura Marholm in the eyes of many of her contemporaries was seen as a traitor against feminism, the feminists of today are more interested of her and her view on the special features that womanhood consists of (K. Tuohela 2002:19-20, 37).

[31] According to A. Strecker and V. T. Lathbury (1954) femininity is to be defined as “the biological and psychological art of being a woman (in M. J. Buhle 1998:194-195).

[32] Legislation becomes, in fact, the main tool for the maintenance of the bureaucracy (P. Klevius 1992, 1996).

[33] This proposition does not exclude the sex-segregated basis for other famous psychoanalysts as well (e.g. Jung).

[34] A considerable amount of informal contacts and inquiries has been performed via telephone, fax, e-mail meetings etc.

[35] This is in line with the view of Göran Ewerlöf - a member of the group that created the proposal 1989/90:28 – according to whom they clearly apprehended the concept as belonging to child psychiatry although there where no researchers or references involved (2002).

[36] Not every social welfare secretary was immediately accessible or able to respond. Sometimes they were too busy or reluctant to answer. In these cases the researcher followed the advices/names offered as alternatives

[37] The setting thus resembles a real, random child protection case reported by phone.

[38] A synonym is Swedish “relation” (English “relationship”).

[39] Fadime was a woman whose father was sentenced for having murdered her in the aim of protecting the “honor of the family”.

[40]  Bo Vinnerjung is a civil servant at the Swedish Social Board and a former foster home inspector.

[41] (Ds 1996:57, p.210)

[42] Young males from Stockholm born 1951 (Stattin et al 1997:205).

[43] The concept “early interventions” is here understood as a criminal policy strategy. Because LVU is not aimed as a tool for protecting the society against crime, the connection is by necessity diffuse. If LVU cannot be used as a tool for protecting the society from crimes but only for the benefit of the child or youth’s personal development, by which channels then should the protection of the society be conducted? When the police arrests a suspect of minor age they have to transfer him/her to the social welfare authorities who have to focus on the individual, not the protection of the society!.

[44] Self-confident supervision seems to be the trademark of attachment.

[45] The social attachment/acceptance between parent and society has been less emphasized. Families that do not accept the values of the society or cannot explain them in a satisfactory way (e g immigrants) may transmit this confusion to their children who then create their own, and perhaps delinquent values (Klevius 1992, 1996).

[46] Studies of correlation between child maltreatment and juvenile delinquency show a pattern, and an ecological approach holds some promise, but in Sweden this type of research is a rarity (P. Martens 1992:147).

[47] Today’s trend towards silent and non-expressive parenting because such behavior is considered unhealthy for children, seems to clash with this.

[48] Barnbyn Skå (The Cildren’s Village SKÅ).

[49] The team of sociologists and psychologists at Barnbyn Skå included Sven Hessle referred to above.

[50] Continuity, however, that, in J. Bowlby’s scenario, seems to be limited only to parent and child in one generation, not trans-generationally. As it is, continuity is also emphasized in the UN Convention on the Rights of the Child.

[51] It was, however, psychoanalytic in the sense that it emphasized a gendered mother.

[52] Someone might argue that although institutions may be bad, “psychological parents” e.g. in foster homes, are better off. But if foster homes are transformed into more profitable institutions (behandlingshem/homes for care) nothing seems to have been gained. Apart from this some studies also questions foster homes (M. Bohman & S. Sigvardsson 1980).

[53] E. Fromm’s wife Frieda Fromm-Reichmann is known for the by now infamous idea in 1948 of the “schizophrenogenic mother” who “generates” schizophrenia in their offspring. Despite its widespread consequences it was only expressed in a footnote (G. A. Hornstein 2000:133) and hence reveals striking similarities with M. Mahler´s first appearance on “pathological symbiosis” as well as the discreet incorporation of it in the Swedish law..

[54] “Little Hans” was actually analyzed by his own father, who was supervised by Freud. Hans’ mother had already been in analysis with Freud.

[55] On 9 September Hermine Hug-Hellmuth was found strangled (by the boy she had analysed) on her couch. 2.400.000 Kronen were stolen from her underwear. According to a brief entry by Siegfred Bernfeld in International Journal of Psychoanalysis Hermine expressed a desire in a will a few days before she was murdered, that no account of her life and work should appear in psychoanalytic publications (L. Appignanesi & J. Forrester 1992:196-203).

[56] Anna Freud was a lively child with a reputation for mischief. As a student she was very bored and restless and whined about attending school. This gave her the nickname "Black Devil." Freud wrote to his friend Fliess in 1899: "Anna has become downright beautiful through naughtiness... ". Anna wrote to her father: "I am glad that Sophie (her sister) is getting married, because the unending quarrel between us was horrible for me." (Freud Museum).

[57] Sigmund Freud’s naming of early psychoanalysis

[58] A strategy originating from Charcot and aimed for the dealing of anorexia.

[59] Compare Emma Eckstein case who later became the first female psychoanalyst ever.

[60] The psychoanalytic historiographer P. Roazen criticizes E. Young-Bruehl, for having written a “heavily biased biography of Anna Freud”. This is made possible by a liberal “spirit of tolerance” combined with a “distaste for controversy” that has failed to monitor books on the history of psychoanalysis. In Young-Bruehl’s biography no more than three pages are devoted to Anna Freud’s views on psychoanalysis and feminist thoughts and Karen Horney is not even mentioned in the book. This is the more remarkable when Young-Bruehl considers Anna Freud “her generation’s most scientifically exact and wide-ranging theoretical and clinical contributor” (P. Roazen 2000:283-285).

[61] It seems that A. Freud never discussed the “Adolescent Revolt” in terms of a natural outcome from the increased time gap and subsequent decreased level of attachment between teenagers and parents in the modern era.

[62] The positive development of the majority of children seems to contradict psychoanalytic presumptions but are invariably either totally neglected or explained due to some children’s extraordinary capabilities to defend themselves against their parents (Swe. “maskrosbarn”, i.e. survivor kids).

[63] If the subjective, human feature of an individual reflects the “real self”, then what s/he does because s/he is paid for to do so does not. Hence the human side of a professional can never be obtained by paying for it because either s/he should have done it anyway without payment or it was not after all her real human, un-professional self.

[64] The reading of Wayward Youth, however, does not support the view that he picked the children in his studies from this environment, rather it seems that the families belonged to the ordinary but poor working class of the time and that the “delinquents” were not that “wayward” at all, but rather simple. The behavior revealed in the book can hardly be associated with the “underworld” unless this expression is an upper-class interpretation on ordinary working families. The latter may well be true having in mind the psychoanalytic movement’s higher middle or upper class character in general. As a consequence this reveals an additional obstacle for the cultural understanding between analysts and clients from different social strata.

[65] According to B. Rune, Mahler is now “out-of-date”, and replaced by Daniel Stern. “Pathological symbiosis” is still of interest, though (2002).

[66] Because Margaret married late she kept her maiden name during this time. In order to simplify the reading I use the name Mahler because all her main writings are made under that name.

[67] This remark seems again to emphasize Anna Freud’s aversion against certain “blood ties”, and the mutual love between child and mother. Biologically inherited altruism (kin selection) is namely the only true form of altruism, i.e. it has not to be learned or considered, and the concept of love can always be traced to biology and egoism. The statement that something is not “the result of altruistic behavior” thus turns to a tautology.

[68] Sandor Ferenczi produced some of the most speculative, and now by most people rejected ideas in psychoanalytic epistemology. He, for example, proclaimed sexual intercourse to be a ”regressive” attempt by the penis to return to the moist warmth of the maternal womb and, beyond that, to the original aquatic environment of primeval times (1924; 1968 trans.: 54 in F. Sulloway 1979:379-381).

[69] We are not told exactly how the observer expressed it but an alternative view more in compliance with the next phrase could have been: Does your mother hurt you? These kinds of “proposals” are easily taken up and used by small children who do not see the seriousness behind the words. In a recent Swedish criminal case a mother was accused for having pushed her small child off a bridge. One of those taking care of him afterwards maybe asked the child if his mother pushed him. In such a case it is almost inevitable that the vulnerable child among these grown ups, will repeat what he then thought was an authoritative description of his situation.

[70] “Childless” in this mother/femininity context should be connected to that very sex segregation it implies and also the concern these female authors themselves seem to have paid to childlessness as a shortcoming as a woman.

[71] After World War II the “self” was downgraded and even replaced by “feminine identity” (M. J. Buhle 1998:354).

[72] “Ferenczi did not analyze the negative transference and she felt that this analysis gave her no lasting insight. Also, Ferenczi gradually abandoned the analytic technique and devised “active techniques”. He gave up the role of the analyst as a neutral interpreter, and actively encouraged, reassured, or directed the patient. This eventually led to an acute disagreement with Freud. Klein, from the start, opposed those developments as being out of keeping with psychoanalytic principles and she grieved for Ferenczi. For Abraham she had unmitigated gratitude and admiration. The fourteen months of analysis she had with him gave her, she thought, a true understanding of psychoanalysis” (H. Segal 1999).

[73] S. Freud erroneously thought that human mind works by virtue of mental ”forces” and ”energies” following patterns of investment and displacement similar to those in a complicated electrical apparatus. Freud writes in his 1894 paper ”The Neuro-Psychoses of Defence” (Sulloway 1979:61). The original psychoanalytic concepts were pseudophysiological and based on little more than a translation of Freud’s ideas about condensation and summation of stimuli into, now outdated, neurophysiological concepts. Freud based his key concept of repression on his own sense of effort in overcoming resistance, and its explanatory power was equivalent with that of  realization, hypnoid isolation, or dissociation. From now on Freud assumed the transformation of the primary process into the secondary, in the resolution of the Oedipus complex and the formation of a superego having the right sexual qualities. The instinctual drives provided different kinds of (psychic) energy affecting the development of adult libidinal sexuality, character traits and object-choice (M. Macmillan 1996:625).

[74] Whether someone, in a situation involving a parent and a child, is against one of them, or just protecting the other, is such a troublesome question that it should not be used for too hasty interpretations. But at least it should be seen as a possibility for questioning an equally over-simplified “in the best interest of the child” interpretation.

[75] “Ferenczi did not analyze the negative transference and she felt that this analysis gave her no lasting insight. Also, Ferenczi gradually abandoned the analytic technique and devised “active techniques”. He gave up the role of the analyst as a neutral interpreter, and actively encouraged, reassured, or directed the patient. This eventually led to an acute disagreement with Freud. Klein, from the start, opposed those developments as being out of keeping with psychoanalytic principles and she grieved for Ferenczi. For Abraham she had unmitigated gratitude and admiration. The fourteen months of analysis she had with him gave her, she thought, a true understanding of psychoanalysis” (H. Segal 1999).

[76] Ekot = The Echo, is the main news magazine on Swedish state controlled radio.