René Spitz, a psychoanalyst, performed research in the 1930s and ’40s on the effects of maternal deprivation and hospitalism in infants who were institutionalized for long periods and deprived of substitute maternal care. His studies focused on infants who had experienced abrupt, long-term separation from their primary caregiver, such as when the primary caregiver was sent to prison. Spitz was one of the first to directly observe infants.
Spitz adopted the term anaclitic depression to describe the child’s reaction of grief, anger, and apathy to partial emotional deprivation (the loss of a loved object) and proposed that when the loved object is returned to the child within three to five months, recovery is prompt, but after five months, a child will show symptoms of increasingly serious deterioration. He called this reaction to total deprivation hospitalism.
Figure 1. Old Royal Adelaide Hospital (Photo Source: Wikimedia, CC BY SA)
Spitz studied children who were evacuated and orphaned as a result of World War II to assess their reactions to separation, including the ability to cope by forming relationships with other children. Results demonstrated that these children experienced stunted development related to height, weight, motor functioning, emotions, relations, and affective expressions. Many forms of these overall developmental deteriorations were thought to be irreversible and some led to child deaths.
Spitz defined these “total affective deficiencies” as hospitalism and concluded that children who have at least six months of satisfactory relations with their mother could improve once the child was reunited with the mother; Spitz defined the latter as anaclitic depression and partial deficiency.
Most of this research was not published until after the war and only gradually contributed to the understanding of young children’s reactions to loss. Ultimately, these studies of young infants being separated from their maternal caregiver led to recommendations that children need responsive, nurturing caregivers for their overall well-being.
Infants without warm, nurturing, supportive care and affection will develop anaclitic depression.
When this type of care and affection are returned to infants within three to five months, the infant will most likely recover.
When this type of care is denied to infants for more than five months, the infant’s anaclitic depression will continually worsen.
Anaclitic depression can stunt development in height, weight, motor function, emotions, relations, and affective expressions.
Hospitalism—a child’s reaction to total deprivation.
Ainsworth, M. D. (1962). The effects of maternal deprivation: a review of findings and controversy in the context of research strategy. In M.D. Ainsworth & R.G. Andry (Eds.), Deprivation of maternal care (pp. 97-165). World Health Organization.
Spitz, R. A. (1946). Hospitalism: a follow-up report. Psychoanalytic Study of the Child, 2(1), 113-118.
Spitz, R. (1950). Relevance of direct infant observation. Psychoanalytic Study of the Child, 5(1), 66–73. ↵
Spitz, R. (1946). Anaclitic depression. Psychoanalytic Study of the Child, 2(1), 313-342. ↵
Spitz, R. (1945). Hospitalism: An inquiry into the genesis of psychiatric conditions in early childhood. Psychoanalytic Study of the Child, 1(1), 53-74. ↵