Separation-Individuation

Normal autism. During the autistic stage—the first four weeks of life—the infant spends more time in sleeplike states than in states of arousal (Mahler 1967). The infant is thought to operate in a closed system, not distinguishing inner from outer, and to be protected by a stimulus barrier, a hypothesized protective shield against overwhelming stimulation. Experience centers on internal stimuli such as hunger, elimination, and bodily comforts. Infant life is concentrated on the satisfaction of needs and on the reduction of unpleasant tensions that relate to these internal states. The caregiver's gratification of the baby's needs is central, and it is out of this experience of gratification that the infant begins to differentiate "good" pleasurable experiences and "bad" painful experiences (Mahler 1967). At this stage feelings are islands of experience not yet held together by a sense of self or other.

Attachment, an intense emotional bond with the mother, begins to consolidate experience for the infant. The ability to attach to the caregiver and others is essential for emotional health. The absence of attachment-seeking behaviors such as smiling, reaching out, and anticipatory nursing postures are felt to be the result of constitutional or basic cognitive defects that interfere with the infant's ability to organize experience. Clinically, the absence of these behaviors can also be tied to profound environmental stress (Mahler 1952; Rutter 1971). Children who are unable to form attachments, or whose attachments have been ruptured though separations or abuse, are withdrawn and suffer from depression (Spitz 1965).

Clinical issues include panic states arising over loss of the self, or, alternatively, a wish to deny any differences between self and other (Pine 1979). The failure to establish an attachment is often seen in psychopathic characters where there is simultaneously an inability to keep rules, a lack of empathy for others, and a craving for affection, along with an inability to form lasting relationships (Bowlby 1944).

Normal symbiosis. The normal symbiotic stage, starting in the third to fourth week, results from maturation of sensory processes. The infant shows increased awareness of the outside world, as indicated by states of alert inactivity. During this period there is an increased responsiveness to the caregiver, who acts as an auxiliary ego in regulating internal states. Memory traces of the caretaker's ministrations help the infant become aware of the differences between inside and outside. Mutual cueing, the way in which the caretaker selectively responds to the infant's needs, sets up a process of interpersonal relating that leads to the development of a core concept of the self (Mahler and Furer 1963). The social smile is the developmental milestone of this period, indicating the infant's attachment to its caregiver.

Clinically, disturbances in ongoing consistent care can lead to deficits in the organization of the self. In the absence of this care, infants may precociously develop their own resources defensively, developing a false self (Winnicott 1953). Attachment is affected when there is difficulty in establishing self-object differentiation. Individuals with these issues lack a core sense of self and manifest a defensive detachment to others, low self-esteem, and a grandiose self structure, that is, a pseudo self-sufficiency to compensate for a lack of connection with another (Horner 1984).