A crucial theoretical premise

Between 1945 and 1946 Renè Spitz, an Austrian naturalised American psychoanalyst, compared two groups of institutionalised children. The first consisted of 220 minors, children of women detained in a women’s prison, who had the opportunity personally to dedicate themselves to their children in a nursery school attached to the structure. The second one, instead, included 91 infants abandoned by their family and admitted to an orphanage.

Spitz observed that, in both cases, the children were adequately treated from a medical, hygienic and nutritional point of view, but in the second group, despite the presence of professional nurses specially trained for the care of infants, the children presented a worrying clinical picture. Many of them did not grow regularly; they suffered from evident delays in cognitive and motor development — with symptoms such as lack of response to external stimuli, expressionlessness of the face, muscle spasms and crying spells. In the first month, the children expressed themselves with complaints and signals, but already from the second month, crying started to be accompanied by weight loss. In the third month, behaviours such as refusal of physical contact, insomnia, absence of gesturing and further continuous weight loss appeared. Gradually also these symptoms disappeared and, after the third month, when the crying stopped, a real lethargic state took over which sometimes led to extreme consequences.

37.3% of the children under observation died — but it would be better to say that they let themselves die — within the second year of life, and this remained inexplicable using only medical tests and parameters.

These symptoms disappeared, Spitz pointed out, when the child found his/her mother or in any case where a person who wanted to take care of him/her dedicated time to communicative and playful interactions and to expressions of affection both in physical contact and in words, as well as in responsiveness to their signals.

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The child does not need only material care

Such a major trauma could not be completely resolved in a short time and Spitz demonstrated how developmental delays and an increase in the mortality rate were detectable in all of the subjects observed, alongside a marked lowering of the immune defences.

Therefore, Spitz (1945) took into consideration an explanation, drawing on his knowledge as a psychologist and psychoanalyst: the child does not need only material care, which considers his/her being only for the physical and bodily part, but also and above all to establish a strong emotional bond with the mother (or a person who regularly cares for him/her with affection and warmth). The smiles, the caresses, the tone of the voice of a human being who cares and the affectionate physical contact stimulate positive reactions essential for healthy development. The already developed self of the adult hosts and allows the creation and development of the child’s self through a continuous interaction involving sensations and emotions transmitted with words, tones of voice, posture and gesturing, which contribute to the creation of a real ‘symbolic world.’ If this type of interaction is absent or is missing for a prolonged period, the child feels abandoned, s/he loses his/her communication potential and becomes unable to find vital reference points.

In essence, sterile and impersonal treatment, although hygienically flawless and medically oriented, which addresses the child as an ‘object’ to be treated with medications and nutritional dosages, is not sufficient to guarantee attachment to life as much as the affective and relational interactions.

The emotional stress caused by the lack of a real caring figure in a ‘maternal’ sense has serious repercussions on the child’s development, giving rise to a series of significant disorders, both physically and psychologically. Deprived of the affections and of the necessary emotional dynamism present in a human relationship, the child becomes apathetic and indifferent, starts to lose weight and gets sick more easily because the body does not produce the hormones and defences necessary for growth and health. Even from the motor point of view, s/he is unable to make the movements considered normal for his/her age and s/he can die in a few months or years.

The Covid-19 emergency and the ‘protection’ measures

As we heard the numbers, due to the pandemic, of deaths, ICU patients, incubating people and infected people, we gradually got used to the requirements imposed for our physical protection. The emergency is just that and in emergencies you cannot split hairs. We locked ourselves up in the house, suspended our main activities (mostly), closed the schools, disregarded all forms of assistance for vulnerable people, forbade visits to care homes and cancelled events and meetings, weddings and baptisms, hangouts and reunions.

We had been told that, alongside frequent hand washing, we had to sneeze into the crease of the elbow and get used to wearing masks every time we left our homes. The expression ‘social distancing’ was introduced which immediately, in a developmental psychologist’s mind, worryingly recalled Spitz’s research. But we were in an emergency and perhaps those who thought it up hadn’t gone too far, in fact.

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What makes human beings human are precisely those social interactions

However, it would have been enough to refer to the definition of health adopted by the World Health Organisation, which describes it as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,’ to be more aware from the beginning.

The unfortunate expression ‘social distancing’ remained and remains. In spite of what even in the health field should be an epistemological foundation of care, it continues to appear in every new document, no matter if it is dedicated to children in the 0–6 range or to older people, to medical personnel or to those serving in supermarkets, relatives or groups of friends.

As psychologists, we see all the dangers associated with the expression ‘social distancing,’ thinking of Spitz’s research from the 1940s and all subsequent literature on the social dimensions of human development and on the social foundations of our own nature, which characterises us among all other living beings. In fact, what makes human beings human are precisely those social interactions — now forbidden by norms — demonstrated by various authors belonging to very different theoretical psychological currents such as Lev Vygotskij (Rieber and Carton, 1987), Urie Bronfenbrenner (1979), Rudolph Schaffer (1996) and Luigia Camaioni (1997), just to name a few in random order.

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Affective and social protections

We must not give up trying to replace that oxymoron, because the adjective ‘social’ is better suited to words such as proximity or closeness. We must strive to avoid that expression that is so much a harbinger of unease or limping health, and to use instead the more neutral expression of ‘physical distancing’ because, although one meter away, emotional dynamism and relationships can still occur for children above two years, adults or older people.

We must urgently ask and demand a ‘repair’ to this enormous communicative mistake — hoping that it will only remain a communicative mistake — before it is too late and that, as with the children observed by Spitz, we all get sick with the same degenerative depression he described.

We can imagine the many ways to be physically distant while staying close socially; we just need to really want it. In this sense, however, the guidelines that require the use of masks to staff on duty in services dedicated to childhood are worrisome, since children can decode a big part of communication only if they see facial expressions and non-verbal indicators coming from the significant triangle made by eyes, nose and mouth. If it is really not possible to do without masks, then the obligation should be for masks with transparent inserts, which give visual access to the area of the mouth, so as to give the possibility of interpreting the mood of the other: a fundamental process to establish mutual relationships.

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We can educate ourselves to new forms of respectful social relationships

Structured opportunities must be given to adolescents, who need social relations between peers so much to consolidate their identity as adults, without which they risk remaining entangled in the dependence on family interactions, both by condescension and rebellion. Community spaces must be open for them to stay in small groups, coordinated by professional workers able to step aside for as long as necessary for boys and girls to organise themselves in modalities protected from contagion, simply giving them useful instructions to avoid contagion and the time they need to learn new mental patterns of social interaction not mediated by technological tools. All you need is a circle of chairs set in a safe way, a lawn with mats stretched out at the right physical distance, an urban wood in which each one can rest against a tree trunk. As long as it is not possible to be sure that the infection is completely excluded, we can educate ourselves to new forms of respectful social relationships, without having to suppress them due to simplistic reductionism or lack of creative commitment.

Now that the grip of the emergency has loosened, it is necessary to start a new phase of different considerations; we will be able to survive the pandemic, but living fully and with psychological well-being requires that the social and emotional dimensions, which so powerfully characterise the human life, are seriously and urgently taken into consideration.


  • Bronfenbrenner, U. (1979). The ecology of human development: experiments by nature and design. Cambridge, MA: Harvard University Press.
  • Camaioni, L. (1997). The emergence of intentional communication in ontogeny, phylogeny, and pathology. European Psychologist 2(3):216–225. https://doi.org/10.1027/1016-9040.2.3.216.
  • Rieber, R.W. and Carton, A.S. (eds.) (1987). The collected works of L.S. Vygotsky: Vol.1, Problems of general psychology: including the volume Thinking and speech. London: Plenum.
  • Schaffer, H.R. (1996). Social development. Oxford: Blackwell.
  • Spitz, R.A. (1945). Hospitalism: an inquiry into the genesis of psychiatric conditions in early childhood. Psychoanalytic study of the child 1:53–74.
Paola Nicolini

About the author: Paola Nicolini is a Professor of development psychology and education psychology at Dipartimento di studi Umanistici of the University of Macerata.

Translated by Silvia Randazzo, EFRJ Editorial Committee Member