jean-marc scholl liège-belgique [email protected]

Jean-Marc SchollLiège-Belgique

[email protected]

«Unease in the Situation of Being Alone» and Separation Anxiety:

Semeiology from Early Childhood to Adolescence.

« Unease in the Situation of Being Alone »

and

A new concept of time.

« Unease in the Situation of Being Alone » and A new concept of time

1. A semeiological study 2. Results of the study 3. A new concept of time 4. The permanence of the feeling of

self 5. Comorbidity with the "Unease in

the Situation of Being Alone"

« Unease in the Situation of Being Alone » and A new concept of time1. A semeiological studyClinical phenomenon : Certain children have a more pronounced predisposition to feel a

sense of unease when they are left alone.

Objective :To work out a more precise semeiology of “Unease in the Situation of Being

Alone" a age-sensitive developmental pattern of the condition.

Method : Detailed collection semeiological data by means of clinical case

studies.

Population : 170 children from 2 to 12 years of age in consultations for children’s mental health issues data gathered between 2002 and 2007.


1. A semeiological study

2. Results of the study

2.A) Developmental pattern of "Unease in the Situation of Being Alone" in children :

Already as an infant, the subject requires the presence of another person in order to be able to fall asleep;

At around 2.5 years, with the beginning of schooling away from home, the child has difficulties accepting this separation from his or her parents;

At around 5 years, the child shows an aversion to playing alone without the presence of another person or an animal; if he or she does play alone, then he or she will constantly ask where the adult is;

With the onset of sleep, the child often calls out to his or her parents, and will sometimes even leave his or her bedroom or ask to sleep with the parents;

At around 8 years, he or she will have no difficulties leaving the house and the immediate presence of his or her parents, for example to go to play with neighbourhood friends. Nevertheless, he or she will be ill at ease if one of the parents should leave the house temporarily.



2.B) “Unease in the Situation of Being Alone”

in adults:

The adult has trouble verbalizing this feeling, which is in fact unaccompanied by any representational content. He or she speaks of an empty “void” or a “nothingness”;

tries to delay going to sleep;

reads in bed in order to avoid this feeling;

seeks to generate fatigue in order to be able to fall asleep quickly.




2.C) If this “Unease in the Situation of Being Alone” is present during day:

The adult who feels this sense of unease during the day will try counter it by one or more of the following 4 means:

1. various activities; 2. sensory input (leaving the radio and TV on in

various rooms); 3. filling up of his “internal world” (say by

reading); 4. a pet.


1. The semeiological study


3. A new concept of time

3.1.) “Unease in the Situation of Being Alone” seems to be correlated with a delay in the “apprehension of time.”

The specificity of this delayed “apprehension of time”:

It is not a difficulty in acquiring a notion of temporal sequence;

It is not a difficulty in acquiring a sense of rhythm;

Rather, it is a difficulty in the apprehension or "foretaste" of temporal duration.





3.2.) A new concept of time :

“The internal gauge by which we anticipate temporal duration”

This sense of time is a capacity: to “savor” the duration of time; to feel how long a period of time will last before it unfolds; to locate oneself within this period of time; to have a sense of time which consist in a “feeling” of the time; N.B. This sense of time is a “feeling” that is UNACCOMPANIED by

representations (mental images)





3.2.) The semeiology of a deficient ability to anticipate temporal duration

causes the 5-year-old child (even if the child has acquired the rational notion of sequential time)

to ask repeatedly when a given activity will occur during the day, even though he or she already knows the answer;

to feel a constant need to revisit the day’s schedule;

to be confused or disoriented if there is a change in the organization of the day;

to have difficulty identifying his or her temporal location within the structure of the day.






When the child is older (for example around 12 years old), he or she:

has difficulties estimating correctly the time needed to perform a given activity;

cannot adequately structure the time required to complete a given activity;

has trouble choosing which of a given range of activities is best suited to filling a given interval of free time (for example, the 45 minutes between the completion of homework and the start of dinner);

exceeds time limits; is unaware of the passage of time;

because he or she is incapable of estimating, gauging, and intuitively anticipating a given stretch of temporal duration






If “Unease in the Situation of Being Alone” is present during the day, it can engender:

a feeling of “nothingness” or of “emptiness”;

a tendency in the child to cling to his or her mother, in order to avoid the uncomfortable feeling of “nothingness,” “emptiness,” and “boredom.”





3.4.) Hypothesis 1:

“Unease in the Situation of Being Alone” seems to be correlated with a defective capacity to get a “taste” for the duration of a stretch of time in the future.

This is a clinical observation!





3.5.) Hypothesis 2 :

“Unease in the Situation of Being Alone” is connected with a deficiency in the neurophysiological platform that enables the subject to estimate temporal duration, that is, “the internal gauge by which we anticipate temporal duration.”

Clinical observation: Not all babies present an “Unease in the Situation of Being Alone”





4. The permanence of the feeling of self

4.1.) Hypothesis 1: The defective capacity to anticipate the “flavor”

of temporal duration can lead a feeling of “nothingness” or “emptiness.”

This deficiency prevents “mental representations” from generating a feeling of permanence. By themselves, such “representations” are insufficient. As a result, if the subject is bereft of a “physical presence” (say of another person or of a pet) or of sensory “stimulation”, he or she tends to experience a feeling of “nothingness” or of “emptiness.”

The baby experiences a feeling of distress when he or she finds himself or herself alone.






4.2.) Hypothesis 2: The feeling we have been describing is a

sense of unease UNACCOMPANIED by representations.

The adult finds it hard to verbalize the feeling of unease, which is unaccompanied by any representations; he or she will sometimes speak of it as a feeling of “nothingness,” or “emptiness”. The unease we are describing is too basic for words.



4.3.) Hypothesis 3: “Mental representations” by themselves are insufficient to

give the subject a sense of his or her own permanence; such representations need to be bolstered by the feeling for time we have been discussing. Otherwise, the sense of being “stuck” in a kind of temporal “void” will continue.

This suggests the following hypothesis. Freud famously observed an infant playing with string on a bobbin. Freud interpreted this game as a symbolic representation of the child’s capacity to acquire a mental representation of the mother that enabled it to endure her temporary absence. By contrast, our work suggests that Freud’s emphasis on mental representations as guarantors of the sense of permanence is insufficient by itself to account for the phenomena.

In sum: Mental representation alone does not yield the sense of permanence; it needs to be complemented by the feeling for time that we have been discussing, a feeling that is itself non-representational, since it resides in the capacity to “savor” temporal duration by way of anticipation.



4.4.) Hypothesis 4: A feeling of “nothingness” or “emptiness” may be offset by

activity, sensory stimulation, or the presence of another being, such as a pet.

The subject, who feels empty and ill at ease, especially during the day, spontaneously seeks to offset this feeling by one or more of the following five methods:

1. External activities (taking a walk, cleaning, and so forth); 2. Internal activities that fill up one’s “inner world” (reading,

intellectual activity, the computer); 3. External sensory stimulation (a radio or TV switched on in

every room; stimulation of the five senses); 4. Proprioceptive stimulation (proprioception connected

with sports, bulimic satiation, a sensation of hunger, autostimulation, or automutilation);

5. A pet to keep one company



4.5.) Hypothesis 5:

When the condition we are describing reaches a sufficiently serious degree of intensity, it undermines the permanence of the feeling of self. This may in turn dilute the solidity of one’s selfhood and hinder the process of individualization.

In one subgroup, the feeling of “nothingness” or “emptiness” can cause momentary a loss of the sense of the permanence of the self.

In this case, “Unease in the Situation of Being Alone” can occur even in crowded places (the cinema, a conference room, etc.) when the subject is separated from anyone he or she knows. The adult is visited by a sudden feeling of unease when he or she loses sight of the person who had accompanied him or her and he or she no longer knows where to locate that person. The subject experiences this “unease” as a void of representation and a loss of the feeling of the permanence of the self.



4.6.) Hypothesis 6:

The basic challenge in meta-psychology would not be for the subject to go through a process of “individuation through separation”, but to attain more fully to his selfhood and to a sense of the permanence of the self.

Daniel Stern has demonstrated that the normal infant has «the “sense of an emergent self” already at the age of 2 months. Stern also shows that the “sense of a core self” develops between 2 and 7 months of age. “The sense of a core self” includes the experience of self-agency, self-coherence, self-affectivity, self-history, as well as the sense of one’s own enduring permanence, of a continuity with one’s own past. Thanks to this sense, one is sure that one continues to exist, and even that one can change while remaining the same.»


The basic challenge, then, would not be to achieve separateness, but to live out one’s selfhood in the ensemble of one’s perceptions, as well as to acquire a sense of enduring individuality.

1. The semeiological study2. Results of the study3. A new concept of time4. The permanence of the feeling of self

5. Comorbidity with the "Unease in the Situation of Being

Alone"

“Unease in the Situation of Being Alone” is present:

systematically in cases of bipolarity, though without being pathognomic for bipolarity.

The condition is present at threshold levels in “maniacal temperaments”.

It can become more pronounced with the appearance of a depressive state.

in other nosological entities (e.g., borderline, schizoaffective, and psychotic disorders).

in an isolated state as a simple personality characteristic of a given

person.


1. The semeiological study2. Results of the study3. A new concept of time4. The permanence of the feeling of self

5. Comorbidity with the "Unease in the Situation of Being

Alone"

"Unease in the Situation of Being Alone" can appear suddenly during childhood, adolescence, or adulthood:

In that case, it may constitute a subgroup of "school anxiety" or "school phobia".

It is also found in connection with the appearance of "negative symptoms".


Jean-Marc SchollLiège-Belgique

[email protected]

«Unease in the Situation of Being Alone» and Separation Anxiety:

Semeiology from Early Childhood to Adolescence.

« Unease in the Situation of Being Alone »

and

A new concept of time.

jean-marc scholl liège-belgique [email protected]

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