The Piggle: An Account of the Psychoanalytic Treatment of a Little Girl (Penguin Psychology) [Paperback]

Gabrielle's parents brought her to Dr. Winnicott's office because she had trouble sleeping, anxiety problems and because she was not herself. Other symptoms included nightmares, difficulty controlling her temper, difficulty in concentration, and listlessness. When she was first seen, she seemed to withdraw from relationships with people. This flight from other relationships and premature independence caused alarm her parents. Gabrielle's sister was born when Gabrielle was 21 months old. The Piggle exhibited jealousy and regressive behaviors (acting more childishly than she was developmentally). Gabrielle presented what some people might call alarming fantasies. They were fantasies gone wild and they consumed her so that she seemed to live inside them somewhat like an adult psychotic might do. The fantasies Gabrielle presented have a "through the looking glass" quality at times. She had trouble telling reality from her dreams. Verbally, a complex story emerged full of "babacars," "yams," "sush babies," "moo's burrr's" and "bryyyyyh babies." These were her made up words for things or people in her world.

Because the child lived far from Dr. Winnicott's office, her parents had to travel a long way by train to be seen. For this reason she was seen on demand or whenever it seemed necessarily. There were only 14 sessions during the whole course of treatment which began when she was two and a half and ended when she was aged five.

During the beginning of the treatment Gabrielle was having frequent nightmares. She would not admit to being herself saying rather that she was this or that imaginary person. She would often say that "the piggle" had gone away. She was full of aggressive feelings. Many of these fantasies appeared to relate to her mother's pregnancy. The "Sush Baba" was her sister Susan. Her parents suspected Gabrielle had tried to become prematurely independent when Susan was born but could not sustain this because she did not have the emotional skills and resources to do so. They are quoted as saying, "when Susan was born, Gabrielle seemed somehow thrown out of her mold, and off from her sources of nourishment (p. 20).

Gabrielle is concerned with "nastiness" (p. 99), her own and that of others. About this issue, Winnicott shows us how people, even children symbolize their experiences in interlocking images, ideas, and feelings. Strange and complex mental representations occur in even two year olds.

Winnicott is showing us through direct case history how the oddity of psychoanalytic child therapy plays out. For example, Winnicott says, "Here she was eating the plastic man. I said she was eating the man because she wanted to eat me." Then he says, "If you eat me that would be taking me away inside you, and then you would not mind going" (p 105). This is said to three and one half year old Gabrielle who is playing with a plastic toy. Winnicott is speaking metaphor to her and what he is saying is that Gabrielle misses him (the plastic man represents him) when she is away. If she could internalize a symbolic representation (a memory) of him she would not mind going home so much and would be able to tolerate the separation because she could evoke her memory of him to comfort herself. Gabrielle speaks metaphor also and she understands what he means when he makes the interpretations of her actions. When psychoanalytic people talk of this they say internalization, introjection, incorporation, or transmuting internalization to refer to phenomena in this general ball park. This is the technical language of metapsychology and Winnicott does not need to refer to it to explain the situation. It makes reading him much more accessible and much less tedious.

As the treatment progresses, both Winnicott and Gabrielle's parents agree that "Gabrielle showed growing confidence now in my ability to tolerate muddle, dirt, inside things, and incontinence and madness" (p. 105). (That's a good thing.)

As the treatment is nearing termination, Winnicott receives very high praise from the patient, `Dr. Winnicott is a very good maker-better of babies.' (p. 107).

All in all, this book is a very good read containing a startling amount of information despite the relaxed tone and jargon-free language. It makes a good starting point for acquiring a professional understanding of psychoanalytic treatment methodology and is understandable with a little help by most parents.

Marilyn Graves, Ph.D. is a clinical psychologist in private practice who sees children, adolescents, and adults. She also writes book reviews and parenting articles.