It is with great joy that we celebrate today the birthday of Donald Woods Winnicott, who would be 125 if he were alive. As we have said before, the best tribute on can pay to a scientist and thinker is to put his legacy on view and in action. Winnicott’s legacy is his extraordinarily original work and his plea for us to carry on the revolution he started.

Winnicott’s legacy is not limited to psychoanalysis, even if he has become particularly well known within that discipline, for his contributions extend to all fields of healthcare, and indeed to every directly or indirectly related area engaged in the physical, emotional, and intellectual development of children, adolescents and even adults. Over and above the new and extraordinary clinical perspective   he unfolded, Winnicott’s thinking reaches the broadest issues of human existence.

In a text about Donald Winnicott written by his widow Clare, one finds the following portrayal:

Given his personality, his training and experience, and his urge for discovery, it seems inevitable that he would concentrate his researches on the so far comparatively unexplored area of earliest infancy and childhood. His findings, however, are recognised by many as having implications far beyond the immediate area of study. It is the expressed opinion of some that they throw light on all areas of living. (Psycho-Analytic Explorations, p. 2)

This is one quality of Winnicott’s work that we at the Winnicott Institute of São Paulo have always emphasized, namely, the breadth of his thinking and the range of healthcare areas and social/institutional clinical practices that can profitably be guided and aided by his revolutionary new perspective, in terms of understanding and treating both the simplest and the most severe and complex cases.

Soon after Winnicott’s death on January 25, 1971, on the eve of his book Playing and Reality coming out, the International Journal of Psycho-Analysis published, in the Obituary section, tributes paid to him by, among others, Masud Khan, considered his only psychoanalyst disciple. Masud Khan begins thus his homage to Winnicott:

Dr Donald Winnicott died suddenly at his home on Monday, 25 January, at the age of 74. With his dead, the living tradition of one man’s sustained clinical dedication, across some 50 years, to the care and facilitation of children and adults to psychic health and maturity, changes into a rich heritage and responsibility for his colleagues and co-workers. [emphasis mine]

Dr Winnicott started his long psychotherapeutic odyssey as an Assistant Physician at the Paddington Green Children’s Hospital in 1923, where he worked for 40 years. […] Gradually over the decades, the impact of his researches has permeated in all the neighbouring disciplines, from paediatrics and psychoanalysis to social work and education. He was a true revolutionary without a dogmatic evangelical programme (Int. J. Psycho-Anal., 1971, 52:225)

In this quote, we should take notice not only of the breadth and reach of Winnicott’s clinical practice – the various areas that coexisted and cross-fertilized in his work – but also of the fact that the responsibility mentioned by Khan bears directly upon us, professionals dedicated to therapeutic work in psychic health.

Winnicott has indeed left us a legacy, one of inestimable wealth: a compelling theory of human nature based not on notions of psychic forces in conflict within a closed system, a concept borrowed from physics by Freud, but on foundational and universal aspects of human beings – for instance, the idea that every human inherits an innate tendency to maturation, i.e., a progressive integration into a unified personality, an I. To be satisfactorily realized, this tendency, although innate, depends fundamentally on an imponderable factor: how the environment responds, or does not, to the basic needs of the individual from the very beginning and throughout life over the various stages of maturation. In other words, going against the grain of the leading psychoanalytic positions of his time that emphasized the intrapsychic milieu, Winnicott pointed to the crucial importance of the environment, especially in the early phases when dependence is absolute.

In formulating his theory of maturational processes, especially with respect to the more primitive stages when the foundations of personality are being laid, Winnicott is guided by the question of what are the basic needs of the individual who inherits the tendency to maturation. In particular, he inquired into and observed the environmental conditions that favor, or fail to favor, the tendency by which an infant, initially immature and highly dependent, eventually becomes a viable person – a person capable of establishing relationships with the external reality (i.e., of accepting the separation Me/not-Me) without losing the thread that connects oneself to the subjective world, a person able to make sense of being alive and to manage (even if no more adequately) his or her own life.

The concept of health, understood as the ongoing maturation that results from the satisfactory resolution of different tasks over the course of one’s life, enabled Winnicott to conceive disorders as interruptions of this process due to insufficient environmental facilitation. The nature of a disorder varies according to the maturational moment in which a difficulty sets in, and this provides the therapist or professional engaged in cure or prevention with a roadmap of the etiology of each disorder. The classification of disorders is primarily maturational and only secondarily symptomatic.

Expressed in these terms, Winnicottian psychopathology makes a fundamental contribution to psychoanalytic practice by guiding diagnoses and providing a lodestar for therapists, who need to be aware of their patients’ emotional age, both to grasp their manifested immaturity and to accompany them in the various stages of maturation, including the phases of great dependence. This horizon is particularly auspicious in the treatment of so-called difficult cases not covered by traditional psychoanalysis. This theory also allows us to rethink therapeutic procedures in several other fields of health – pediatrics, child psychiatry, speech therapy, nursing, occupational therapy – and to delineate the types of maturation-abetting care that pertain to social assistance and to education. Furthermore, it is a particularly precious contribution for everyone involved in policies of prevention.

By dedicating himself to the study of the earliest stages of maturation, Winnicott became a master of details, of the particularities of early relationships. He shed light, for instance, on silent communication – or, as he put it, the “magic of intimacy” – that develops between the baby and a good-enough mother capable of empathy. This primitive communication, still wordless according to Winnicott, is the basis of all future forms of communication that one will develop throughout one’s life.

What Winnicott gleaned from his concurrent pediatric and psychoanalytic practices with psychotic adults was essential for him to formulate his theory and develop the various clinical aspects of what he called “modified psychoanalysis” (i.e., specially adapted to the treatment of severe cases) and of his unique clinical work, the Therapeutic Consultations.

Regarding his ability to communicate with children, J.P.M. Tizard, a pediatrician who was Winnicott’s disciple and worked with him at Paddington Green Children’s Hospital, wrote in the International Journal of Psychoanalysis’ Obituary dedicated to Winnicott following his death in January 1971:

I first got to know Donald Winnicott 22 years ago when I became a physician at the Paddington Green Children’s Hospital. I went there with a poor opinion of the general usefulness of child psychiatry but I soon found that however difficult and damaging a child’s past and present circumstances the situation was always changed for the better once Dr Winnicott became involved. At first I attributed this to his obvious high intelligence, his intuitive powers and the fact that he was “good with children”; but while all these attributions were correct, I later realized – and I am sure he would have liked me to say so – that his success also owed much to his professional discipline and his training as a psychoanalyst. Donald Winnicott had the most astonishing powers with children. To say that he understood children would to me sound false and vaguely patronizing; it was rather that children understood him and that he was at one with them. (Int. J. Psycho-Anal. 1971, 52:226)

More than understanding children, Winnicott was understood by them. He spoke their language, he communicated with them. I believe it can be said that, in fact, the entire Winnicottian oeuvre is an exercise in communication, almost as a matter of principle, in his lectures to different audiences eager to listen to him. The fact is that the question of the possibility of communication is the centerpiece of Winnicott’s studies on human nature: not only is the capacity for communication (even the most primitive, guided naturally by the capacity to identify with the other) the preeminent skill of the good enough mother/environment, but the impossibility of communication, for an individual, is the most general and poignant of the unthinkable agonies.

Elsa Oliveira Dias

This article was read at the Forum “Pregnancy and Birth: In Commemoration of the 125th Anniversary of Winnicott’s Birth”, organized by the Beijing Mental Health Facilitating Center and the Beijing Winnicott Study and Research Group, on April 7, 2021

July 1, 2021