Breastfeeding

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Suckling is the action whereby milk is fed to the infant until it is weaned. By extension, the term refers to breastfeeding as well as bottle-feeding. Before an emphasis was placed on the importance of the object and the infant's environment, psychoanalysts spoke little of maternal suckling. However, Sigmund Freud, in a text that needs to be viewed in historical context, titled "A Case of Successful Treatment by Hypnotism," evokes the case of a young woman, "occasionally hysterical . . . who is willing to feed her infant but behaves as if she doesn't want to" (1892-93a). The dimension of the unconscious conflict is not taken into account here and Freud clings to the idea of will and counter-will. An outline of maternal psychopathology is given, and here the difficulties of breastfeeding are treated by hypnosis.

Suckling is not a psychoanalytic concept. In speaking of suckling we cannot forget the physical link associated with the reality of the nutritive relation. The image of the infant at the mother's breast has considerable metaphoric and symbolic value; it is an image that makes us nostalgic for a sense of original fulfillment and can be compared with that other, "final," image of death, as characterized by the iconography of the old man at the breast. The container, the breast, and its content, milk, are both associated with projected fantasies. The milky substance, a liquid that contrasts with the solidity of the breast, is a vehicle of fantasies of fusion and vampirism. Once the infant's teeth begin to grow, the fantasies are those of oral sadism and cannibalism. There is an analogy to be made between the breast and the penis, between milk and sperm, one of which nourishes and one of which fecundates, and at the same time an incompatibility because sperm is, in fantasy at least, supposed to spoil milk; thus there is a separation between the sexual and the nutritive.

A dichotomy has always existed between the breast as a nourishing object and the breast as an erotic object, a separation that helps avoid the confrontation between an incestuous mother and the importance of maternal libidinal and erotic investment. However, in The Interpretation of Dreams (1900a), commenting on the "dream of the Fates (Knödel), Freud wrote that "at the woman's breast love and hunger meet." For the breast satisfies both the alimentary and the sexual impulses: "To begin with, sexual activity attaches itself to functions serving the purpose of self-preservation and does not become independent of them until later. No one who has seen a baby sinking back satiated from the breast and falling asleep with flushed cheeks and a blissful smile can escape the reflection that this picture persists as a prototype of the expression of sexual satisfaction in later life" (1905d). The nipple is a sexual object throughout Freudian metapsychology. The transition from sucking the nipple to sucking is a key moment in the organization of the earliest feelings of autoeroticism and investment of the mouth as an erogenous zone. Freud does not mention (Laplanche, 1997) the erogenous erotic component for the mother during breast-feeding. For the infant the breast assumes (secondarily) its forbidden erotic value with the organization of the oedipal conflict; initially the infant simply "is the breast" (Freud, 1941f [1938]), during a period of primary identification with the breast and primal fusion.

It has become obvious that the object plays a key role in enabling the polarization of the libido into certain zones. This follows their unification when the infant is breastfeeding and the libido experiences a sense of satisfaction, at a time when the mouth that sucks and the nipple that nourishes are inseparable and indistinguishable. The mother "(moreover) makes a gift to the infant (while she is lavishing her attention on him) of feelings arising from her own sexual life . . . and clearly grasps these as a substitute for a separate sexual object" (1905d). Freud returned to this position and developed it in his Outline of Psychoanalysis: "She is not content to nourish, she cares for the infant and thus awakens in him many other physical sensations, agreeable and disagreeable. Thanks to the care she lavishes, she becomes his first seductress. Through these two relations, the mother acquires unique importance, incomparable, unalterable, and permanent, and becomes for both sexes the object of the first and most powerful of his loves, the prototype of all later amorous relations" (1940a [1938]).

The role of the object and precocious maternal seduction as it occurs through breastfeeding are questioned by contemporary analysts. Jean Laplanche (1987) has developed the idea that sexuality is implanted in the infant through the initial seduction of the adult, and emphasizes the unconscious sexuality of the seducer. From this follows the possibility of a significant reassessment of the role of the impulses, the role of the object, and anaclisis; he also raises the question of the primal. For Paul Denis the question of mastery is present at the heart of the initial experiences of feeding, but the encounter between the mouth and the nipple, to the extent that it combines kinesthetic and sensory feelings, instinctual excitation and pleasure/unpleasure, is an essential period during which the activity of the initial representation takes place (the "pictogram" of Piera Aulagnier, 1975). For authors such as Esther Bick, the emphasis is on the presence-absence of the breast during this primitive stage of undifferentiated autosensuality characterized by the encounter between mouth and nipple. The role of the object remains essential for enabling the consensual union and unification of the libido. The mother's container function is experienced as a "skin": "The optimal object is the nipple in the mouth, together with the mother's touch (holding), speech, and familiar odor"(1968).

With respect to bottle or breastfeeding, Freud responds only in terms of privation. In all cases there remains a feeling of "having sucked too little and for too short a time," the nostalgia for the breast being stronger for the child who has been bottle-fed (1940a [1938]). Melanie Klein (1952), writing about breast-and bottle-feeding, returns to the question of the primacy of the object and instinct, the importance of the exterior object and the reality of the breast. For her the breast is the object of intense fantasized projections because it is a primordial object. The cannibalistic oral impulses directed toward the mother's breast are especially intense. As for the mother, the fact of feeding her baby has a restorative effect because it terminates the sadistic fantasies with respect to her own mother: "The nourishing and beneficial milk she dispenses signifies for the unconscious that her sadistic fantasies have not been realized and that their objects have rediscovered their integrity"(1932).

For Donald Winnicott breastfeeding is expanded to the baby's environment in the broad sense and to the richness of the experience the mother offers. The quality of maternal holding and handling is essential, for these are both a function of the mother's internal conflicts and of her own infantile experiences. The foundations of psychic health depend on this "facilitating environment." The experience of the survival of the object in the face of the baby's attacks seems to her essential and in the end helps her advance the idea of difference "between the survival of a part of the mother's body and the survival of a bottle" (1987). Although he is cautious when discussing mothers and does not dismiss the unconscious maternal implications, he emphasizes the importance of the carnal reality of the experience of the breast; in this body-to-body relation, the exchange of glances and the sensual experience are essential to communication.

Breastfeeding is a situation that so profoundly involves the mother's body and psychic life that it is subjected to the unconscious conflicts that affect the mother and to the fantasies awakened through the encounter between a specific mother and a specific infant. Suckling extends the period of pregnancy and birth and is inseparably a part of the woman's sexual life and her life history. Primitive psychic activity is associated with these very first contacts that are always difficult to conceptualize. Psychoanalysts who care for infants are conscious of this in their clinical activity and research.

The invention of the bottle (1820), followed by the introduction of sterilization (1892-1898), have profoundly altered breastfeeding. Artificial milk eliminates the need for direct recourse to another woman, in the position of wet-nurse, and the baby's survival (in reality) no longer depends on the product of the mother's body. The transition from mother's milk to artificial milk, while it abandons its natural origins, cannot be assimilated to the transition from raw food to cooked food discussed by Lévi-Strauss. But how can social and cultural ideology be made to mesh with unconscious maternal choices?

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