Promoting Mental Health: Supporting Early Relationships Does Not Mean Blaming Parents


As both a pediatrician and psychoanalyst, D.W. Winnicott had a unique view of human development. In his pediatric practice, he was immersed in the lives of developing infants and parents. (As the mother was usually the primary caregiver at the time he was practicing, he writes primarily of the mother-baby relationship.) In his psychoanalytic practice where his patients, in his words “regressed to dependence,” he had a kind of mothering experience with an adult person who could communicate with both body and verbal language.

In preparation for teaching a course on early childhood mental health at¬†William James College, I had the pleasure of reconnecting with the profound wisdom of his writings. While¬†Winnicott wrote extensively for both a general and a professional audience, I discovered, on careful re-reading of his essay for a general audience entitled¬†“The Ordinary Devoted Mother”¬†that it contains a vast wealth of ideas. In fact, if I had to assign only one paper for the entire course, this could be it.

He begins in his delightfully humble way by saying that he had no wish to tell mothers what to do because, ” To start with, I didn’t know.” Like his American counterpart Benjamin Spock, he acknowledges the mother as the expert with respect to her child.

Identifying how his approach is sometimes misinterpreted as blaming mothers, he calls attention to an inherent conflict. He writes:

“But is it not natural that if this thing called devotion is really important, then its absence or relative failure in this area should have consequences that are untoward?”

Later in the essay he returns to the problem of blame, but first points out that this ordinary devotion is contingent on the mother herself being cared for.

‚ÄúI think that by the time the baby is ripe for birth the mother, if properly cared for herself by her man or the welfare state or both, is ready for an experience in which she knows extremely well what are the baby’s needs.”

Had he been writing today, he would likely call attention to the profound implication of our failure to support mothers in the postpartum period, as represented by the absence of government-sponsored paid parental leave. We are uniquely lacking in a culture of postpartum care, as I describe in detail in a previous post.

Next Winnicott introduces another central concept of his, referred to in other works as “the holding environment.” He identifies the profound nature of the care a mother offers:

“You will understand I am not simply referring to her being able to know whether the baby is hungry or not, and all that sort of thing; I am referring to innumerable subtle things, things that only my friend the poet could put into words. For my part, I am contented with the word¬†hold, and to extend its meaning to cover all that a mother is and does at this time.”

He then goes on to speak of what in his other writings he refers to as the “good-enough mother.” He describes how a mother in a healthy way fails to adapt completely to her baby’s needs, in parallel with his growing ability to manage frustration.

“In time the baby begins to need the mother to fail to adapt–this failure being also a graduated process that cannot be learned from books. It would be irksome for a human child to go on experiencing omnipotence when the apparatus has arrived which can cope with frustration and relative environmental failures. There is much satisfaction to be got from anger that does not go over into despair.”

This concept has been supported in the research of developmental psychologist Ed Tronick, who has shown that these very disruptions, along with their subsequent repair, give a developing child a positive sense of himself.

Winnicott then returns to the idea of blame, wisely pointing out its close connection to the concept of guilt, an experience that comes naturally with the role of parent.

“Here I must go back to the idea of blame. It is necessary for us to be able to look at human growth and development, with all its complexities that are internal or personal to the child, and we must be able to say: here the ordinary devoted mother factor failed, without blaming anyone. For my part I have no interest in apportioning blame. Mothers and fathers blame themselves, but that is another matter, and indeed they blame themselves for almost anything.”

He sticks with his conviction that we cannot shy away from calling attention to the importance of the mother-child relationship for fear of being accused of blaming parents.

“But I have one special reason why I feel we must be able to apportion etiological significance (not blame), and that is that in no other way can we recognize the positive value of the ordinary devoted mother factor–the vital necessity for every baby that someone should facilitate the earliest stages of the process of psychological growth, or psychosomatic growth, or shall I say the growth of the most immature and absolutely dependent human personality.”

Contemporary research at the intersection of developmental psychology, neuroscience, and genetics is revealing more every day of how early experience gets into the body and brain, and how disruptions in early relationships can lead to long-term problems of both physical and emotional health. Winnicott anticipates this knowledge when he writes:

“Psycho-somatic existence is an achievement, and although its basis is an inherited growth tendency, it cannot become a fact without the active participation of a human being who is holding and handling the baby. A breakdown in this area has to do with all the difficulties affecting bodily health which actually stem from uncertainty in personality structure. You will see the breakdown of these very early growth processes takes us immediately to the kind of symptomatology which we find in mental hospitals belongs initially to infant care.”

He concludes with the following observation, which can serve as a kind of call to action for our society to nurture and protect these earliest relationships.

“It will be observed that though at first we were talking about very simple things, we were also talking about matters that have vital importance, matters that concern the laying down of the foundations of mental health. A great deal of course is done at later stages, but it is when the beginning is good that all that is done at later stages can take effect.”


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion‚ÄĒbroadly speaking‚ÄĒof psychiatry and its treatments. The opinions expressed are the writers’ own.


Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.


  1. Good article.

    Winnicott was a great writer, one of the legends of psychoanalytic developmental theory… right up there with Sullivan, Fairbairn, Bion, Klein, Jung, Freud.

    This part, “apportion etiological significance (not blame)” – gets to the heart of the matter. Identifying a parent as a causal agent who, via (often unintentional) neglect or abuse, causes the child to become troubled, is not blame. It is simply realistic. It is identifying something that is happening which, if it is denied, cannot be productively addressed or changed.

    Denial is the primary orientation of biological psychiatrists to the negative causal influence of abusive, neglectful parents upon their children. Instead of becoming aware of how their poor parenting harms their children and how they might make a better relationship with their child, parents are lied to on multiple fronts by psychiatrists – told that their child has a brain disease, that they need drugs, and that the influence, either negative or positive, by the parent onto the child, is relatively unimportant or not important at all. This latter idea is a notion that any person with common sense knows is bullshit. Good parenting and bad parenting matter a hell of a lot. I hope will more people will start to reject the reductionist horsecrap that is fed to them by their antidoctors.

    Report comment

    • “parents are … told that their child has a brain disease, that they need drugs” from BPDtrans
      “Mothers and fathers blame themselves, but that is another matter, and indeed they blame themselves for almost anything.” from the article

      Don’t you believe in the magical medication? Psychiatry is a religion of worship of magical pills.

      Report comment

    • I think it’s also important to note that much of “bad parenting” comes from cultural influences and expectations, many of which came from the field of medicine or even directly from psychiatry itself. Remember how worried we were all supposed to be about picking up our babies for fear of “spoiling” them? Whose idea was that, I wonder? What about the widespread and systematic suppression of nursing in favor of formula feeding in the 50s and early 60s? Directly from the medical profession. Feeding schedules, advice NOT to read to your kids when they were young, advice that parents should never disagree in front of their kids but should always present a “united front” – all of these pieces of culturally accepted advice came from medicine and from psychiatry/psychology.

      Parents can try their hardest and still not do what their kids need, sometimes because they have had bad information or advice, or have never had positive parenting modeled for them. Rather than blaming, the process of identifying these issues EMPOWERS parents to re-learn the wrong information and poor modeling they received and to become the kind of parents they want to be for their own kids. Denying that “good enough” parenting is an absolute requirement for adult mental health is about as smart as suggesting that eating poor quality food doesn’t affect a child’s growth and development. It’s a straw man put up by NAMI and the psychiatric profession to justify the medical model. The “don’t blame the parents” argument doesn’t serve parents OR kids well at all.

      —- Steve

      Report comment

  2. Narcissistic parents can be a problem for the kid, because the parents’ needs will always overshadow the child’s and the parent will expect the kid to satisfy their emotional needs, usually by demanding their child ‘be’ a certain way so as to not inconvience or embarrass the parents. I believe this is rather common.

    Sometimes it is appropriate to blame the parents becaue they can be obvsiously at fault and refusing to go there just translates into denial, so healing will never occur because clarity is never reached when in denial, Plus, that is where repeittion occurs, so the trauma would more than likely continue.

    But it is never necessary to get stuck in blame and resentment. One can forgive and distance themselves from narcissistic abuse, and one can also take responsbility for their lives, regardless of anything that may have occured in the past.

    Once you know the core cause of social trauma and negative self-image, you can heal it. But not if you’re stuck in blame, then we render ourselves powerless. At some point, we, ourselves, need to take over and correct what needs to be corrected, internally. Then, our reality can shift into a more clear, grounded, and present time reality.

    Report comment

  3. Hi Steve

    I agree that listening to parents and helping them to support their children can be empowering. I find your idea interesting that resisting “blaming parents” is a way of perpetuating the medical model of disease that places the problem squarely in the child. Is it really better for a child to be given the sense that he has a diseased brain? When put in such stark terms it seems obvious that the answer is a firm “no.” This contrast highlights the way the child does not have a voice. As you point out, not only does this approach silence children it also disempowers parents.

    Report comment

    • Quite so. If the child’s brain is to blame, then the parents are off the hook, the teachers are off the hook, the psychiatrist is off the hook, even the child is off the hook, and only “the disease” remains to be blamed. This may be reassuring in the short run, but in essence says that no one can do anything to change the situation, which is the ultimate in disempowerment. We wring our hands and try drugs, and if they don’t work, the psychiatrists wring their hands with us and bemoan “the progress of the disease” instead of admitting they don’t know what the heck to do other than give the kid more drugs.

      I’ve talked to lots of foster kids coming out of the system to adulthood about this issue, and they generally find it insulting. “You mean to tell me that despite the abuse and neglect I experienced and the involuntary placement with people I don’t know and separation from my family, friends, neighborhood, teachers, and apparently random moves to yet other foster homes over many years, that I’m supposed to be CALM and HAPPY about all this, and if I’m depressed or angry or anxious or hopeless, it’s because my BRAIN is broken?!!” It is hard to convey the contempt in which most of them hold the “mental health system” and especially attempts to medicate them into compliance or emotional neutrality.

      When you see what else can be done, and how totally empowering it is when parents are able to start to face the demons of their own upbringing and/or learn some new skills that WORK, it is simply shocking that the psychiatric community continues to get away with the fraud they are perpetrating on the public.

      Thanks for your writing and your reply!

      —– Steve

      Report comment

      • My mother once said to me that if I were to tell her that she, in any way, harmed or wounded me unwittingly, she would die on the spot. And she said it angrily, basically warning me to not ever blame her for anything. This was years after I had come off psych drugs forgave my dad for his abuses and re-established a relationship with him.

        So, despite the obvious double-bind I faced, while also realizing how this mindset must have affected me when I was growing up, I thought eventually, “Hmmm, how am I going to be able to communicate the complexity of how the family dynamic affected me, based on who I am and my own set of personal sensitivities, as we all have, while getting across to her that there is a very good reason in present time having to do with my self-care that I don’t attend family functions?”

        That’s when I decided it was time to make a film about this, so that I could provide her with a context for my trajectory involving mental illness and healing. I brought others in, too, who felt their family issues were highly relevant to their journey through the system, so that she wouldn’t feel alone in this, as though I were targeting her, personally, but, instead, to show that this is a pattern in society, where family issues lead to scapegoating and once you’ve turned to the mental health field, you get diagnosed and drugged, and pretty much get stuck in that role. So it becomes layered trauma, very messy, and one can easily start to feel powerless and hopeless because it is never-ending in that particular journey.

        Suddenly, it seems impossible to know what caused what, what is and isn’t ‘normal developmental growth process,’ and most importantly, how to find the light at the end of the tunnel and get on with things, moving past these primitive family issues. They don’t have to affect us adversely forever, if we don’t allow them to. In fact, it becomes guidance to our path, beliefs, and often, our purpose in life.

        I work with families, now, in my practice, thanks to how my own family dynamics took me through a fascinating journey of healing and awakening. First thing I do is to introduce the perspective that the ‘identified patient’ is the healer, and the family healing is guided by the evolution into wellness of the one who has been diagnosed. To me, this is the most reasonable and effective way to reverse the damage from family trauma–shift the roles. A lot of truth comes to light in that process, for everyone to face and deal with, one way or another. Of course, some choose to avoid, but some do not, so there is hope.

        So I made Voices That Heal and sent it to my mother and to the rest of my family, and that brought more clarity, and then dialogues ensued between us. Some went better than others, there was some defensiveness, but it’s always a work in progress.

        Overall, now years after all of this, my family has evolved well and continues to be doing so. All except one family member who refuses to change in any way, and who continues to try hold me in a stigmatized role, albeit unsuccessfully. He does this of course because my wellness is very threatening to his ego, and to his self-identity. That’s common as we heal.

        Yet, he has no evidence of his particular construct of reality regarding me, while I have all the physical evidence in my life, and all around me, of transformational healing. Busted right through that family stigma, and now the reality of the one continuing to cast stigma is the one that is held in doubt. Been incredibly fascinating to experience this core family shift.

        So, indeed, the roles have changed, and everyone has made their choices. Some took the healing, one did not.

        And my mother is still very much alive, doing well, happy and healthy at 83. So she learned that not only would the truth NOT kill her, but that instead, it would lead to her health, happiness, and, finally, a sense of freedom–all of which had eluded her most of her 55 years of married life with my dad.

        And so it is…

        Report comment