Dr. Sergio Romano, Psychology Psychotherapy, Psychodrama

Rene Spitz, Ospedalismo, Anaclitic depression: research and follow-up.

Rene Spitz, Ospedalismo, Anaclitic depression: research and follow-up.

Sergio Romano

Click to Watch Video: Overt primary Rejection in Infancy (Hospitalism) :: Study by Rene A. Spitz 1952


With the term Ospedalismo, is designated a body condition flawed due to a prolonged stay in hospital, or the morbid condition of the atmosphere that characterizes the hospital and more generally indicates the harmful effects of life in institutes, on younger children.

Some data: in Germany at the beginning of '900, one of the largest children's homes had a mortality rate of 71,5% (within the first year of life, Schlossman, 1920); in the U.S., in the same period the percentages ranged from 31,7% to the 75%. In particular in Baltimore, the 90% of these children, died within the year (Chaplin, 1915) and to Albany, al Randalls Island Hospital, was 100%. In the 40s at Bellevue Hospital in New York, the rate was lower than the 10% (Bakwin, 1942). If, therefore, had improved the living conditions within the institution, because many children continued to die?

In those years, scholars such as Durfee, Worf, Bender, Goldfarb, Lowrey, discovered that under the age of three months, the children showed no signs of institutionalization, but that after eight months of residence, showed signs of severe psychiatric disorders. After three years the damage was irreversible. They isolated the factors responsible for the damage: Lack of stimulation (sterile environment, aseptic), the presence / absence of the mother.

Spitz, well acquainted with these situations, and in spite of those who would like a little objective, deemed it insufficient data because the sample is not representative, view of the small size and because they were given IQ tests, (inapplicable to the first year of life). He decided to use the test Hetzer and Wolf (1928) which provided information not only on Q.I., but on developing globally understood (perception, body control, memory, intelligence ..). With these data it created a personality curve to make comparisons intra-individual and inter-individual.

He decided to undertake a study to find out what factors could affect more or less relevant, on child development. He spotted two institutions, in two different western countries, for a total of 130 children up to the age of, then 34 subjects raised in the house as comparison sample. So four areas. Then proceeded as follows:

– Medical history of each child.

– Data analysis on mother, where possible.

– Hetzer-Wolf tests or other tests designed specifically, administered to all children.

– Making movies (960.000 cm of film shot!).

One of the two institutions was one nursery, the other one brefotrofio. The development test It found an important: children reared in the nursery and at home, showed good development, more or less homogeneous, those in orphanage, But no (una media in 105 counter 72!).

He also showed that children in the orphanage, had started out with an almost normal, and then decreased gradually. From the third month onwards, showed physical signs / psychic dell'ospedalismo.

Its 88 not morirono 23, for measles epidemic. In practice, disease resistance had fallen heavily. The survivors were still "damaged", from many points of view.

In contrast to these data, in the Nursery, as a bit 'older (8-12 months), were enterprising, active, clambering, walked..

What were the differences and similarities between the two institutions? The children of the nursery were the sons of mothers offenders, locked up in the prison which was part of the nursery. The children of the orphanage, had a similar background in part of previous children, but the best part; were the children of mothers who were not there to keep the. In fact, the quotient of recent evolutionary children, initially was better, precisely because of the more favorable background.


Both institutions were located outside the city, in large gardens, and had good sanitary conditions; children up to six weeks staying in different environments, more sterile. In both children were transferred after two / three months, wards with the greatest, in individual compartments enclosed by glass, on four sides with regard to the nursery, from three sides in orphanage. In the orphanage there were up to 15/18 months, in the nursery after six months were in rooms to 4/5 beds; in the orphanage, the children were half and half in dimly lit areas near the windows.

In the nursery the cells were stained, in both walls were clear; white beds in both; the nursery possessed greater financial resources, in fact, there were a table and a chair close to the sun. In the orphanage, find a stool was already very.

The food was good and in sufficient quantity in both, feeding bottles sterilized, most of the smaller children was breast-fed up to three months, more in orphanage.

The clothing, the covers, temperature, were good in both.

Regarding the health aspect, in the nursery, the children were visited on request, while in the orphanage daily.

So far, few differences, or if we want a condition a bit 'better in the orphanage. Then?

In the nursery There were toys, orphanage in no, at least initially; after, by way of the search, toys began to appear there too, brought by observers.

In the nursery you received an impression of warmth, mothers were busily, the children could see out of the windows located on both sides, see other children.

In the orphanage, the corridors were deserted, the nurses were present only for meals. There was also a habit that says a lot about how little you know about the real needs of the child: the sheets were hanging on either side of the sun. In this way, the children saw nothing, were completely isolated! In the nursery, the children were moving in the sun, a space in which up to about 10 months was sufficient. In the orphanage, stood still for months, to the point that you created in small depressions of the mattresses on which small and unfortunate creatures lay. A 10/12 months, the only games were their feet, their hands. In the orphanage there was a nurse and 5 for nurses 45 children, in a nursery nurse and three assistants who teach mothers how to look after their children. So there was always a mother to a child, his or that of another. Although these mothers a little extravagant, that is not too "regular", were in any way present.

In the orphanage weaning, with the consequent disruption of human contact, happened to four months, development began to slow down so.

The criticism here refer to the possibility that this slowdown was due in general to the perceptual deprivation and in particular the absence of the mother. Spitz, responded by stating that the relationship with inanimate objects for a child under one year of age, is not so important. For him, the perception is the result of the intervention of an emotion (function of cathexis libidinal). Emotions come to the baby through the human partner.

The child knows the environment through the mother. She introduces him to imitation learning and then. The presence of the mother, can compensate for the other deprivations, but not vice versa. True that in the orphanage the child is isolated, but for Spitz, is not what the problem, but it is the absence of the human partner, hence the importance of the mother / child for children under one year of age.

In the orphanage surprising, over which the reduction of the quotient evolutionary, the diversity of reactive modeling to outsiders eight to twelve months; Avoidance anxious to be great friendliness toward inanimate objects.

Spitz decided, given the data collected, to carry out a follow-up, which consisted nell'incaricare a researcher to visit each 4 months the orphanage, within two years of research. Data were collected body of children, taking photographs, asked questions to the staff, made movies.

But the 91 children with an initial, of them died in the first year 27, for different diseases, according to others by 7 (37% mortality); 23 had gone, 7 adopted, 2 transferred, four not heard anything.

21 of those involved in the first search, were still in place. The youngest was 2 years, the largest 4. All were strongly delayed in several respects. Even physically the delay was awesome; a child of two years on average is high 85 cm and weighs 12 Kg. Only three were part of these parameters, the others were underdeveloped, up to a limit of 45% below the average for the weight, and the 15 % for the height. Data showed classic of children of the mid-.

This follow-up, confirming the irreversibility of the process. Note that in 15 months, the children were transferred to other departments with children, with more nurses, in a more bright and sunny, with good stimulations, nonetheless, the deterioration continued to increase. Changing environmental conditions too late, not needed. A similar study was done in the nursery, the other institution where the research was carried out initial: here everything was different. The children played, parlottavano Su ... 122 children observed for a year and a half, no one died, unusual given in the nursery, as he emerged from the examination archives.

Anaclitic depression

Observing 123 children (ethane understood and translated 12 e i 18 months) in a nursery, found that after six months, some children showed behavior with crying, sadness and then a closing themselves. They were still in bed, absent, if set crying. This behavior lasted for about two / three months. Then insomnia, weight loss, increase in diseases, decrease in the Q.I..

After three months the crying decreased, took over from stiffness, stillness. They were fixed. Sometimes there were autoerotic activities. The contact was no longer possible. Its 123, 19 showed these symptoms. For all 19 very similar; was a syndrome.

These children were observed for 400 total hours, for each, in a year, weekly.

For other 26, a syndrome similar but milder. The research showed that some factors were not relevant, such as sex, race, age (within a certain limit, compreso tra i 6 and 11 months), developmental level and intellectual.

While one seemed to be significant: all of them had been removed from her mother. Other children did not show this syndrome; they saw that the necessary condition, for the development of this syndrome, was that the separation had occurred during the first year of life and that it lasted long enough. Then: deprivation as a necessary condition but not sufficient.

If we analyze these symptoms, we can see how they are similar to those characteristic of mourning, already described by Abraham in 1912 Good Freud e nel 1917.

Which, the fact is the trigger loss of the love; Spitz, a child who manifests the syndrome, is comparable to an adult who is suffering from melancholia, which, however, can be expressed verbally. The differences are justified by the difference between the two psychic structures in adults and children: while in adults have developed psychic instances defined, the child may be visible, Io ed only one is deboli, making it therefore vulnerable.

Counter, the fact that the ego is at the dawn of its existence, offers the advantage of making it possible, in a relatively simple method, the replacement of the love object as a result of loss.

In practice what he called Spitz anaclitic depression, comes close to what Freud called simple depression, e Abraham (1912) defined Paratimia primaria.

By the Klein invece, As is well known, depression is Fons et Origo development; for her depression comes when the child between three and five months, perceives the mother as a whole thing. Considers a stage of development.

Spitz thinks that Klein did what they did, according to him, Young, Rank, Wealthy, Eagle, which for out of the way sexuality from psychoanalytic theoryModified the theory ....

Depression, view spitziana, is not an integral element development: is a disease.

Bringing together children deprived of their mother, the change was amazing, for both speed and for amplitude: in some cases was visible over 12 hours!

Unfortunately,, the research group of Spitz, was able to follow the children only 18 months, so it is not possible to know if the effects of deprivation, the trauma suffered, left traces or not. In anaclitic depression, as well as in the mourning, assist in recovery efforts of the object, activated as attempts to replace, recovery of the lost object or the lost world. In melancholia we have a super-ego, which crushes me, causing the vain of the id reaction, as producing anxiety, the superego uses some of the energy needs of the id for its destructive, de-sessualizzando such energies.

It has ciò positive esito (depressive phase), the aggressive impulse of the id is not completely de-sexualized and remains as a resource ego, used for the creation of a system compulsive, which meets at least temporarily the super-ego, interrupting the progress of melancholia. If the sexual and aggressive impulses of the id, do not end at the service of the superego, they are to reinforce the ego, which has the better of the superego, coming to incorporate. This results in a abolimento limits between systems and it has the fase maniacale.

All this applies to the adult. In small child we are not in the presence of super-ego; qui la loss of the love amounts to a deprivation hostile and he reacts with his weak, inadequate. At this age we speak of a I especially body. The locomotion will tend to reward the need for social relationships anaclitic; in the first half in a passive way, since it does not walk yet, in the second half in an active way. So locomotion becomes a prerequisite. Since this is very limited in institutions, it goes without saying that it is also limited the ability to establish object relations anaclitic, through social contact. By inhibiting the movement, the outburst of aggressive impulses can only be directed toward; differs from melancholy where was the super-ego to crush the ego. Here you do not need.

Spitz, carefully observing, saw that not all children were equally affected by the inhibition of locomotion: depended on what?

The ability of the institution to offer an object of love alternative. Emerged also another fundamental fact from research carried out: depression anaclitic was much more severe in cases where the relationship between mother and child was best before separation.

Deprivation, then, as a primary cause of a number of dramatic consequences.