Extended Breast Feeding: A Proposal for Further Study: Brief Communication

Extended breast-feeding is considered. While breast-feeding has always been considered of positive value for the development of infants, the significance of the duration of experience of breast-feeding for the mother/child couple has not been carefully explored. In this paper an extended duration of breast-feeding is explored with a hope that the significance of the topic will be obvious and encourage more psychoanalytic exploration.


Introduction
In this brief communication, I will put the issue of an extended duration of breast-feeding into the context of existing psychoanalytic literature on the subject. I would like to bring attention to the fact that psychoanalytic professionals have given it insufficient attention. To underscore the importance of the issue, I will raise developmental questions, but not attempt to provide probable answers insofar as such would hopefully come only with greater focus on the issue, including both clinical and empirical investigations. While oral sucking deprivation is equally of importance, it is not my focus in this proposal. While I am strongly in favor of breast-feeding for its psychological benefits for the nursing couple, my interests are to inquire as to the possible consequences of extended breast-feeding.
Why is it that psychoanalysts have paid so little attention to breastfeeding? Insofar as we assume nursing an infant involves an emotional connection between mother and infant, one would think that such an intimate connection would become more of a focus for psychoanalysts who are interested in emotional intimacy and the kind of interpersonal interactions that foster or diminish such an achievement. An important question is why do some women choose to breast-feed, while others choose to nurse their infant with a bottle (assuming it is a choice)? While this is a basic question, our focus is on determinants for a mother, able to breast-feed, to choose to do so for an extended period of time. How long a duration should warrant being labeled extended is, of course, not a simple matter. For the purposes of this paper we are guided by our Western culture popular expectations of any duration longer than twelve to fifteen months as being extended, although we appreciate some might opt for a shorter or longer duration. We have not reviewed anthropological literature on cultures where extended breast-feeding is the norm but is based on nutritional needs and not psychodynamic ones. Future research could consider different developmental effects based on different cultural assumptions.
The nursing couple most often exists within the context of a traditional family that may include other children and a husband. Why do some mothers nurse for a long period of time compared to other women, able to continue, who choose to wean their infant from their breast? What role does a partner (traditionally, a spouse) play in this decision and what are the determinants for them in decision-making? Are there developmental consequences for the infant correlated with or caused by an extended duration of breast-feeding? Are there developmental consequences for other children in the household based on an extended period of breastfeeding for a newborn sib? A lack of apparent interest (judging from the lack of publications) by analysts either in clinical or empirical studies has delayed clarification.
Health organizations, such as the World Health Organization and the American Academy of Pediatrics, propose standards for exclusive breast-feeding for the first six months with continuation through age twelve months as other foods are introduced [1]. A more controversial and complicated issue has been to recommend a preferred duration of breast-feeding. Based on anecdotal reports, most child development experts and mothers are in agreement that breast-feeding contributes positively to the emotional wellbeing of both mother and infant, at least when nursing goes smoothly without complications. The bonding and attachment aspects are particularly emphasized. But there is not agreement as to how long the nursing couple should best continue. There are influential parent groups that expound the virtues of what they call "natural" child rearing practices, e.g., La Leche League International [2], who on their website advocate extended durations of breast-feeding, i.e., breast-feeding for as long a duration as the mother and infant wish it to be.
A Psychoanalytic Electronic Publishing (PEP) search from 1977-2013 on the topics of breast-feeding and on weaning showed many references, but none seemed relevant to our focus. In an article focused on the maternal aspects of nursing, Friedman [3] commented on the dearth of interest in psychoanalysis on breast-feeding. In her review of the psychoanalytic and non-psychoanalytic literature extant at the time, Friedman (ibid. p.479) mentions only one psychoanalytic article [4] where there is mention of psychological factors in a lactating woman that prompts her to extend nursing. This mother "seduces" her daughter into "prolonged nursing, " to maintain the "mother's oedipal attachment with the dead grandmother" (who died of breast cancer), and "to curtail any potential romantic or erotic relationship for the mother. " Friedman (ibid.) writes in her concluding paragraph.

Pediatrics & Therapeutics
It could be that the analytic gaze from both the analyst and analysand are averted from breastfeeding in order to avoid confronting a situation fraught with unconscious fantasies, memories, and provocative dyadic as well as triadic primal scenes. The compromise of the analyst's seeming disregard staves off such contamination and preserves some shard of a relationship that is mostly out of bounds to the sullying effects of sexuality, aggression, competition, and anger (p. 488).
Friedman implies that there is an idealization of the nursing experience for both mother and child, despite many clinical examples where a mother reports experiencing either sexual or aggressive thoughts about nursing. There is a paucity of more contemporary interest by psychoanalysts in breast-feeding and particularly in extended instances. Even D.N. Stern [5], who pays lots of attention to the mother-infant relationship, "breast-feeding" is not in the index of a recent major book. His focus is on the infant's core sense of self and the eventual development of a core sense of the other. Stern (ibid, p.286) does note that early feeding (not restricted to breast-feeding) experiences are occasions contributing to the emerging relatedness between infant and mother, but he does not address the consequences of the duration of these experiences. A psychoanalytic researcher can turn to the classical literature or clinical cases to generate hypotheses about the topic of breast-feeding.
The concept of the "oral personality" arising ultimately from Freud's original formulation of the stages of libido has relevance for our topic. This character type might be related to a mother's motive for extended nursing and to its effects. Abraham [6] traced the influence of the events of the oral stage on later developments in personality. For example, an especially intense pleasure in biting, presumably expressing both libidinal and aggressive wishes, expressed during the latter part of the oral phase [6] will cause development to proceed under an abnormally pronounced influence of ambivalence, likely to later manifest itself as the character trait of envy. Presumably ambivalence is involved insofar as envy includes both a wish to possess what another does possess (a libidinal derivative) but also to destroy the possessor (an aggressive derivative). The child who is over-gratified (our focus) or deprived as a suckling may develop an oral fixation. Abraham assigns a significant oral fixation to a number of character traits. Several suggest over-indulgence and a high degree of pleasure: "oral optimism, " derived from undisturbed and highly pleasurable sucking, and expressed in "conviction that everything will always be well with them"; generosity through identification with the gratifying mother; and habits of plainly oral derivation derived from excessive gratification, such as excessive craving for food, smoking, etc.
According to Glover [7] shortening of the suckling period is more likely to prove traumatic than will prolongation. With respect to oral "spoiling, " of which prolonged nursing is an example, Glover comments how oral overindulgence may be used by a mother to reduce the severity of other kinds of deprivation, such as irregular feeding. Abraham [6] suggests that delayed weaning can sometimes be to prolong the physical pleasure for the mother.
Psychoanalysts hold differing views concerning the importance and optimal duration of breast-feeding. Melanie Klein [8] maintains that through psychoanalytic therapy one may always discover in a child who has not been breast-fed, an unfulfilled, deep longing for the breast. According to Klein, a fantasy of restoration of the breast is the basis of all later achievement. Freud [9] contends that while the infant's relationship to the breast is the prototype for later object relationships, the breast per se is not really crucial. Klein recommends weaning at about eight or nine months, whereas Freud [10] seems to suggest that the time of weaning is not of utmost importance to a child's development.
The significance of the breast in the development of object relationships is stressed by Anna Freud [11]: "Where infants are breastfed, and the milk and breast are in fact part of the mother and not merely, as with bottle-fed babies, symbolic of her, transition from narcissism to object is easier and smoother" (p.125). Josselyn [12], stressing the role of weaning in the infant's psychic differentiation from the mother, notes that many children will spontaneously wean themselves from the bottle. Emphasizing the role of interpersonal factors in the weaning experience, this author assigns greater importance for negative repercussions to a negative attitude of the mother as compared to reality factors.
Hence, it would appear from the psychoanalytic literature that while breast-feeding is considered of value for child development there generally is neglect of the issue of duration, except for Melanie Klein. When prolonged or extended breast-feeding was addressed early on in psychoanalysis it was formulated that mothers did so for unconscious reasons.

Developmental Questions
There are important developmental issues, some raised above, that may or may not be related to extended breast-feeding. Overgratification often results in an oral fixation and future resulting drive derivatives may be involved in subsequent dynamic consequences for the child. Psychoanalysts, who observe and treat children or supervise child analysis candidates, in clinical discussions often raise questions having to do with extended breast-feeding. What follows is not an exhaustive list of questions but a sampling of the kinds of developmental experiences that may have important effects on young children and family members. These experiences may correlate with or be causative determinants of developing personality structure (ego, superego), drive expression, and the quality of object relations for the nursing child, and have links to effects on dynamics for a family and its members.
For example: Do mothers who elect to extend breast-feeding (beyond 15 months) have a history of their own where they perceived maternal neglect? Do mothers who elect to extend breast-feeding prefer their nursing child to soothe themselves on mother's body rather than autoerotically or to use a transitional object? Do spouses influence a decision to wean? Does extended breast-feeding result in overlapping of libidinal phases, and do drives take on a distinctive oral expression? Can we say similarly about the aggressive drive? Is the breast an unsuitable venue for the regulation of oral (biting) aggressive impulses or of hostile impulses deriving from later developmental phases but seeking a discharge in an oral mode? Because of maternal chastisement for biting do children who experience extended breastfeeding seem to internalize superego precursors at an early age? Does extended breast-feeding correlate with the evolution of intense feelings of envy in a sibling, and is it exaggerated if a newborn sib's nursing on the breast is witnessed repeatedly? Does extended breast-feeding correlate with the following: 1) with a style of learning characterized as "taking in;" 2) with loquaciousness or taciturnity; and, 3) with an inclination to reverie? Is extended breast-feeding related to a delay or enhancement in the development of object love?