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Mental Health in Family Medicine 2016; 12:223-227
Mini Review
2016 Mental Health and Family Medicine Ltd
“protective shield against stimuli” [6,7] or a “psychic protective
envelope” [8,9]. I assume that the processing of narcissism
serves as a protective shield for preserving the self against
alien stimuli that might invade and endanger it. This processing
reveals a narcissistic sensitivity to differentiating characteristics
that emanate from any non-self [10,11] from those experienced
as self. Freud [12] described the sensitivity to these alien stimuli
as the “undisguised antipathies and aversions” that people feel
toward strangers with whom they must interact. The above
helped to consolidate my idea of inborn healthy narcissism as
a preserver of a separate self-familiarity and self-continuity
and as a defense against alien stimulation, essentially, against
otherness [13]. This narcissism as a self-preserving force is
irritated by “minor or major differences” from the familiar [14],
and is triggered “to get rid of the unpleasant awareness” [15]
and of acute mental pain [11,16].
Hence, narcissism is tasked with regulating and restoring
the “coherence of the self” [17,18]. The outcome would be the
retention of self-cohesiveness as a separate self from the non-self
and from the object [19-23], the strengthening of self-integrity
[24,25], the “restoration of primary blissful narcissism” [26],
and the maintenance of the “emotional balance” [11,15].
Utilizing these ideas to think about what I see clinically, time
and again I am impressed to discover how much we are attracted,
from birth, to the familiar. I understand this phenomenon as
reecting a survival mode of immunization, one that, in making
Introduction
In this paper I wish to explore the reasons for the emotional
reaction babies manifest toward an approaching stranger, one
that continues, in attenuated form, throughout the lifespan. It
is well known to most of us, whether as parents, observers and/
or mental health professionals, that infants resist the unfamiliar.
This is commonly referred to as “eight-month anxiety.” The
baby might react to the stranger’s face (and presence) with
apprehension or else show distress and withdraw, resist making
contact, especially with the eyes. He or she may cry or even
scream. This emotional reaction is generally accepted as a
normal one, part of the baby’s development.
In many papers [1-3] the main discussion of stranger anxiety
revolves around the extent to which the baby’s emotional
reaction is one of anxiety. Others have focused on how infants
discriminate among strangers [4] or on the infant’s reactions to
strangers as “an entree into the study of relationships among
cognitive, social and affective development.” [5]
My paper will focus on a novel theoretical approach that
may illuminate this phenomenon, accounting for the emotional
immune reasons for our attraction to the familiar and resistance
to strangeness and otherness.
Healthy Narcissism
The psychoanalytic literature includes widespread references
to various situations in which there is a mental need for a
Stranger Anxiety: When Children Face Strangers
Ronnie Solan
Clinical Psychologist and Psychoanalyst, Independent Pracce, Israel
Till about seven months, the baby mostly ees from contact
with strangers, often avoiding eye-contact without the parent’s
awareness. A reaction of resistance and anxiety when approached
by a stranger is commonly seen around eight months. In this
paper I explore this emotional responding in the context of a
novel re-conceptualization of healthy narcissism processing as
an emotional immune system. Whereas recent discussions in
the literature have focused on the anxiety reaction, I propose
that key to understanding this commonplace phenomenon is the
understanding of how healthy narcissism works to safeguard
that which is familiar and resist that which is strange. The
operation of these psychic processes may be likened to those
of the biological immune system, which safeguard the familiar
codes of the body and repel alien invaders. In safeguarding that
which is familiar and repelling the alien, healthy narcissism
operates as an emotional immune system. It is promoted by
good-enough attachments (object relations) characterized by
our being loved the way we are (true self), in separateness
and not according to someone else’s blueprint (false self), one
that risks invading our familiar self. The more we are loved
for who we truly are, our self-integrity is more immune to
invaders, and throughout our lifespan, we are more immune to
alien inuences, and to the incursions of others’ hurtful words
and deeds. Healthy narcissism is thus understood as providing,
from birth, emotional immunity to our sense of self-familiarity.
We come to recognize ourselves and the partners of our various
relationships via continually being alerted to and subsequently
resisting or rejecting strangers/strangeness (i.e., invaders), and
by gradually tolerating and even befriending the otherness.
Befriending is possible when we are able to discover some
familiarity embedded within the stranger.
The appearance of eight-month resistance/anxiety, a normal
alertness to strangers, signals that the baby has a rudimentary
sense of both self and object constancy and is able to differentiate
between his familiar “not-I,” such as the parent/caregiver whom
he experiences as familiar and is attached to, and the unfamiliar
“not-I” stranger. The parent/caregiver is then experienced as a
bridge between that which is familiar and that which is strange
and anxiety-provoking/overwhelming. Parents’ reactions to the
“not-I” (of their baby) can help the infant differentiate between
a “not-I” he might befriend, and one that is best avoided. The
normal emotional immune reaction reects a good-enough
balance between preserving the familiar and true self, and
befriending the otherness, to which one remains appropriately
but not excessively alert.
MeSH Headings/Keywords: Healthy Narcissism;
Emotional immune system; Child development; Jointness
ABSTRACT
Ronnie Solan
224
us more resilient and immune to various potential threats (both
internal and external), allows us to survive. One such threat, to
which we gradually become more immune, is that of separation
anxiety and its impending dangers. It is mitigated by the
grounding or anchoring provided by the familiar, including the
familiarity inherent in both self and object constancy. Another
set of challenges where we must cope with strangeness is that
of our changing body, whether due to sexual development,
pregnancy, illness, or aging, and the narcissistic threats this may
pose.
Over the past few years, I have described and re-
conceptualized the psychic functions of the attraction to
and seeking of familiarity, and the concomitant resisting and
rejecting of strangeness, as the hallmarks of the operation of
healthy narcissism [11,27,28]. I have proposed that healthy
narcissism constitutes an innate emotional immune system [27]
that protects our sense of a familiar self, our “true self” [29] and
maintains a sense of self-security and self-esteem.
While resemblance between biological and psychic
processing was already recognized by Freud in the late nineteenth
century [30], I wish to draw attention to the similarity of function
I have found between biological immune processes [11,31,32]
and the emotional immune system (including biological and
emotional autoimmunity symptoms), both of which process
incoming data via the attraction to the familiar and the resisting
of strangeness [27]. Moreover, I have suggested that healthy
narcissism fullls both adaptive and defensive functions [11].
For example, when we defensively resist the unfamiliar, we are
protecting ourselves from it and what it may bring in its wake.
When we are able to be curious about and befriend it, we are
adapting to change and we may better tolerate the otherness. It
is beyond the scope of this paper to elaborate these ideas further.
Immunologists describe the biological immune system as
a network of cells and tissues throughout the body, an innate
network that functions together to defend the body from stranger
invasion and infection at the molecular and cellular levels [33]
Similarly, I wish to illuminate here why the baby’s emotional
reaction to that which is strange (i.e., strangers, strangeness)
is normal, protects the sense of familiar self, and constitutes a
healthy emotional reaction. Hence, with appropriate psycho-
education, parents will be able to cope better with their
offsprings’ emotional responses.
I would like to provide a real life example that illustrates
both the baby’s resistance to a stranger, and how the caretaker
can help the baby befriend the unfamiliar, so he is able to feel
secure enough with this stranger, who gradually becomes more
familiar.
Benjamin is eleven months old. He attends a daycare center
and is usually cared for by the same nursery worker each day,
a woman called Sarah. One morning, Sarah has a medical
appointment and needs to leave early, and another employee
arrives to take over the remainder of her shift. Sarah places
the favorite elephant (his transitional object) in the hands of
Benjamin and then introduces him to Alice, her replacement and
he reacts by crying and resisting. Now Sara attempts to hand him
over to Alice. Sarah initiates a game – she and Alice gently take
turns playing a clapping game with Benjamin. This gradually
allows him to feel more at ease in Alice’s company, and within
a few minutes he is able to accept that Sarah is leaving. Sarah’s
actions may be understood as providing Benjamin with a
space in which to transition from strangeness and worry to a
new familiarity as she and his transitional object are bridging
between strangeness and familiarity.
As mentioned above, the emotional reaction to strangers
and otherness starts at birth. It reects a healthy archaic need to
defend the self against alien stimulation, as well as the primal
differentiation of the new born baby between me – my Self” and
not-me – non Self.” [11,27]
Freud [30] was preoccupied with questions of the permeability
and impermeability of stimuli in the nervous system and their
relation to perception and memory. He coined the concept of
a “protective shield against stimuli” [6,7] and recognized its
objective of ltering stimuli in the service of the instinct of self-
preservation [34]. After Freud, many psychoanalysts proposed
various terms to express this need for self-protection [*].
I support Anzieu's [8,9] conceptualization of the psychic
protective envelopes and ego-skin, a formulation similar to
what I have re-conceptualized as the operation of “healthy
narcissism” [27] that produces a sensory map that serves as
a frame of reference for differentiating the outside from the
inside, and the familiar from the alien. The ego-skin or the
healthy narcissism thus contributes to the secure boundaries
of the self. Furthermore, the concept of ego-skin as a sensory
map of memory traces of stimuli [8,35-37], led me to consider
narcissism as a familiar sensory map or network of accumulated
memory traces of our emotional experiences, most of them
interlinked, providing continuity and cohesiveness [27]. A few
years later, Britton [10] also put forward the hypothesis of a
similarity between the mental system and the immunological
system. He did not consider the similarity with regard to
narcissistic features. However, I obtain support for my
assumption in view of Britton’s remarks: “I suggest that there
may be an allergy to the products of other minds, analogous to
the body’s immune system—a kind of psychic atopia …. The
not-me or not-like-me recognition and response might fulll a
psychic function similar to that in the somatic … and whenever
we encounter foreign psychic material, a xenocidal impulse is
stimulated [10].
Gabbard [38] suggests that Freud’s [14] concept of narcissism
of minor differences “can be extended by recognizing the
fundamental narcissistic need to preserve a sense of oneself as
an autonomous individual” . Freud’s remarks may also reect,
in my view, a sense of alienation due to narcissistic sensitivity
facing an unfamiliar person, a stranger that initiates resistance
against these alien stimulations [11,27,28,39].
Till the age of eight months the baby reacts to strangers
mostly by ight into sleep. At about eight months the baby
can already perceive his self as constant (self-constancy) and
each of his parents and the people around him also as constant
(object constancy), although this will be further consolidated
later on. In this regard I join my predecessors [40-44], who
proposed that stranger anxiety appears following the formation
of object constancy. This is why when a stranger approaches
the baby; the baby resists, and may become anxious and burst
Stranger Anxiety: When Children Face Strangers 225
Table 1: Relationships between Mcnair score demographic and clinical characteristics.
into tears. Sometimes he is able to look at his parent’s face to
discern whether this stranger is a “not-me” who is nonetheless
familiar to his parents, in which case the baby may calm down,
or a stranger also unto them, which can elicit crying. I imagine
that almost all parents have noticed this type of baby reaction.
Since it is such a frequent occurrence, I thought it important
to highlight this normal emotional reaction. Furthermore, I
thought that if parents could acknowledge that this reaction
is normal, their reaction to their child’s crying would be more
tolerable. Moreover, very often the baby, just like the adult,
regulates his unpleasant feelings by projecting these “bad”
feelings onto a stranger. Based on the narcissistic resistance to
strangeness, projection (a defense mechanism) is activated by
the ego to expel oppressing inner sensations of strangeness or
of aggression outward, in order to defend the self against the
anxiety of object loss or of abandonment”. [11] “Hence, the
unfamiliar is now experienced as an evil stranger, while the
parent is cathected as a good object (despite the frustrations)
who might protect the baby from the threatening evil
enemy.”(ibid). Aggression is often displaced and projected (ego
defense mechanisms) on to strangers and animals. If the baby/
adult in these situations doesn’t feel protected by the beloved
parent, this “evil stranger” might trigger ooding of stranger
anxiety, hate, suspicion, demonization, xenophobia and racism,
and also phobic or hysteric reactions. In subsequent stages of
development, however, the displacement and projection on to
imaginary monsters or cruel people often triggers nightmares.
We may also inquire as to the aim of our psychological
immune system. Is it to always reject the stranger? Quite the
contrary. The normal emotional immune reaction should reect
a good balance between preserving the familiar and true self,
befriending [**] the otherness, and remaining appropriately
cognizant/alerted to that which is strange.
Here is another example of a toddler that I observed in a
family party and how she befriended her strangeness feelings:
Twelve-month-old Joanna holds onto her mother’s pants
at a family party, only to suddenly realize that the woman in
question is actually her aunt Michele. She feels embarrassed
and immediately turns to nd her mother. Upon nding her, she
enjoys the feeling of safety and of being “at home.” Joanna then
returns to her aunt and once again clings onto her clothing.
This simple game expresses Joanna’s enjoyment in
overcoming feelings of embarrassment that arise from the
sensation of strangeness contained within the familiar coined
by Freud as “Uncanny” [45]. It also allows her to experience
the transition from one emotional state to another, in which the
familiar remains constant. In this way, Joanna befriends and
integrates strangeness with familiarity.
I’ll add another example that my patient shared with me and
how we elaborated his feelings:
During a therapy session, Carl reported being anxious about
his son’s behavior, feeling he was too nice to everyone, even
on the street. He relays that, “When my son was seven months
of age, he used to be in a real panic when a stranger in the park
tried to relate to him. I had difculties to calm him down and
last week he completely changed and I don’t like it either. I
don’t want him to be nice to strangers - it might be dangerous
for him, although he is a boy and not a girl.” After a silence, Carl
suddenly associated to the following:
"When my parents came over for a visit last weekend, they
went to pick up my son, Stephen (aged eight months), who
started to cry. My parents felt upset and handed him straight
back to me. I was very uncomfortable, and felt a sense of shame.
Personally, I couldn’t and wouldn’t spurn their affection like that
… I couldn’t help but feel as though Stephen was not in fact my
son but in a way, a different, unknown infant …. Automatically,
I put Stephen back in my father’s hold, only for him to start
bawling. My actions were not motivated by affection for my
father but rather rooted in a sense of frustration and even rage
towards my child."
I would like to use the theoretical underpinnings of this
article to propose an understanding of the above event, bearing
in mind that additional aspects of the therapy work remain
beyond the scope of this vignette. The boundaries between adult,
mature Carl and baby Stephen became momentarily merged and
Carl perceived himself to be rejecting his own parents, when
Stephen demonstrated normal stranger anxiety. In this instance
Carl was not able to perceive his baby as a separate entity, a
person allowed to register a sense of strangeness toward his
grandparents, who were after all still largely unknown to him.
Carl was cross with Stephen for daring to act in this way
towards his grandparents and therefore causing him to feel
humiliated. At that moment in time, Carl’s anxiety about losing
his parents’ love took center stage over his relationship with his
child as a father. He did not show the appropriate skills in being
able to contain his son’s stranger anxiety. He therefore felt the
need for his infant to be well-behaved or even “nice” towards
the unfamiliar grandparents, who were effectively strangers,
from Stephen’s perspective. At the same time, Stephen’s anxiety
at the thought of somehow losing his dad starts to grow. He
is receiving a clear signal, specically that it is not acceptable
to adhere to what he nds familiar. Neither is it acceptable,
Stephen learns, to reject the strange, unexpected response he
nds in his own father. Stephen now nds himself in a place of
turmoil and inner conict. He nds himself giving in, lessening
his organic resistance to being passed over to people he does not
know. He is forced to “put on a brave face,” expressing himself
in an inauthentic manner. We may surmise that Stephen is not
reacting from his true self but rather from his false self [29].
The above example touches upon a common occurrence
- I’ve often heard parents facing such an inevitable conict.
On one hand, we as parents must contend with the needs of
our baby, which include vigilance towards, and rejection of,
strangers. However, we must also confront our needs (often
shared by other relatives) to be recognized by our infant as
familiar, recognizing that they may be in opposition to the
baby’s needs. The greater the emotional closeness between the
parents and the “strangers,” the harder it is to fully accept the
alienation and the strangeness felt by the infant. We may feel
positive affection and a sense of familiarity with either parent
(or both) and wish to preserve our self-familiarity. At the same
time, one of our children may sense strangeness and resistance
toward their grandparent, given his own need to preserve his
self-familiarity, and we may respond with intolerance toward
his reaction. Alternatively, we may sense a lack of proximity
Ronnie Solan
226
and affection with either or both of our parents while he/she
nds affectionate communication with one of our children.
Conclusion
All of the above led me to realize that we need to be aware of
this parent-child dilemma and acknowledge the emotional need
of our child to resist that which is strange to him. If we wish that
this stranger be welcomed by our child (e.g., a grandparent), it
is up to us to enable a process of gradual befriending, perhaps
via shared play. In this way, we strengthen the child’s healthy
immunization of his familiar sense of himself. Thinking to the
future, this may extend our child’s skills in better tolerating and
befriending the otherness and separateness of his partners. At the
same time, he should be sufciently alert towards strangers who
might threaten his self-security. A sense of balance is crucial.
Understanding the resistance to strangers and to that which
appears strange in the light of the healthy narcissism processing
as constituting an emotional immune system, has helped
me in my psychotherapeutic work with people who suffer
from narcissistic personality or narcissistic disorder, or any
narcissistic vulnerability. As the elaboration of the concept of
healthy narcissism is beyond the scope of this paper, I cannot
illustrate how my new technique shortens the length of these
psychotherapies. However, I can emphasize that I am very
attentive to any association that may strengthen the self-esteem
and the true self of the patient, which proves to the patient that
he/she has this familiar sense of his/her self even though unused
as destructive experiences take over and gain priority over
the positive ones. Unfortunately, it is always easier to destroy
relations due to intolerance of the otherness than to maintain
them, and it is very difcult to rebuild the relations while
respecting the other’s separateness, and enjoying the jointness,
despite injuries and frustrations.
Throughout our emotional development from birth
onwards, we constantly search for familiar persons with whom
we might feel secure and able to communicate with, sharing
a sense of communion or belonging. This is true not only for
love relationships, but for other, less intimate ones. At the
same time we reject strangers (who may also be perceived as
potential competitors, not just alien), keeping them far outside
our shared space with our loved ones. Meanwhile, during our
lifespan, we are forced to confront and manage the narcissistic
injuries we may incur not only at the hands of strangers and in
strange environments (“not-I”) but upon facing the otherness
of our beloved one/s, and often, also the strangeness that we
feel inside our own sense of familiar self (such as during sexual
development, pregnancy, illness, stress.) It behooves us to nd
ways to befriend the otherness and to tolerate it, perhaps even to
celebrate and enjoy it, in what becomes an “art of couplehood”
[11].
Healthy immunity of the familiar sense of the self requires
being able to differentiate the familiar from the strange, and
the ability to develop a balanced, healthy alertness, together
with an increasing tolerance for the otherness emanating from
another person. This balance is important from childhood and
throughout life. A failure to demonstrate a healthy alertness to
strangers may lead to excessive friendliness with them. Along
this continuum, there may be a lack of alertness to potentially
dangerous situations, such as may be seen in certain clinical
syndromes. For example, in some cases of post-traumatic
stress disorder (PTSD), the compulsion to repeat a pattern in
the (unconscious) hope of a better outcome may put the person
at risk. An excessive and uncontrolled alertness may lead to a
sense of repulsion, paranoia, anxiety and panic, coupled with
rejection and a hatred of strangers, and possibly even racism.
In contrast, the balanced and adjusted alertness may take the
form of curiosity, with the baby choosing to investigate whether
the stranger is a friend or an enemy. This curiosity enables the
infant to befriend otherness and strangeness, to try and master
the unknown, and to develop a sense of security, self-esteem,
and enjoyment in exploring his environment.
*These included the “container object” [46], the “mother as
a protective shield” [47], the “holding mother” [29], “psychic
skin and second skin” [48], “ego-skin” and “psychic envelopes”
[8,9], the “protective shell” [49].
**Anne-Marie Sandler [50] described this psychic
movement, from the avoidance of the stranger anxiety
towards the familiar, as a defensive or adaptive motivation,
in order to replace the experience of dissonance (regarded as
an overwhelming experience) with a sense of consonance: “to
gain the security of the experience of the dialogue with what is
known and recognized.”
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Address for Correspondance: Ronnie Solan, Clinical
Psychologist and Psychoanalyst, Independent Practice,
Israel, Tel: 972-3-6425754; Fax: 972-3-6426955; E-mail:
ronnie.solan@gmail.com
Submitted 02 May 2016
Accepted 20 Jun 2016