Bodily States of Anxiety: The Movement from Somatic States to Thought

Barry Proner
London, England
Society of Analytical Psychology

I imagine that every analytic psychotherapy practice is replete with material of a somatic nature, probably in every session. My paper will attempt to explore something of the relation between disturbances in the bodily functioning of one patient in analysis and their associated mental states and images as meaning has unfolded in the transference/ counter-transference relationship.

I shall consider in particular the analytic process in those moments of reversible shift from physical experiences and their mental concomitants, concrete thinking, to phantasy. My thinking about the mental life of this patient has been influenced by the following food for thought, chosen from the vast larder of analytic writings on the subject of the relationship between the psyche and the soma.

In his 1935 exchange with the young Wilfrid Bion at the Tavistock Clinic, Jung said, ‘The psychic fact and the physiological fact come together in a peculiar way. They happen together and are, so I assume, simply two different aspects to our mind, but not in reality. We see them as two on account of the utter incapacity of our mind to think of them together’.

Esther Bick, in her well-known 1968 paper, wrote of ‘the primal function of the skin of the baby … in relation to the most primitive binding together of parts of the personality not as yet differentiated from parts of the body’. (Bick, 1968, italics mine)

‘All archetypes are affective whether they are spirit orientated or instinct orientated. Consequently they must be related in some way or other to physiological processes.’ (Fordham, 1985, p. 162) ‘Imagery is related to affect and affect is as much physical as psychic.’ (Ibid, p. 163) ‘It is also known that early in development disorders can apparently be generated by the infant himself.’ (Ibid, p. 168) On de-integration, of which I shall say more later on, Fordham wrote, ‘In the first place a de-integrate is psychosomatic in the sense that an infant cannot distinguish mental representations from bodily experience.’ (Ibid, p. 170) Indeed, Fordham’s model of the primary or original self is one of psychosomatic unity, based on the nature of the archetype itself, much as Jung implies in his comment to Bion at the Tavistock, which is that it contains psychic and somatic forms together. (Ibid)

Winnicott, in his paper “Mind and its Relation to the Psyche-soma” wrote, ‘To study the concept of mind one must always be studying an individual, a total individual, and including the development of that individual from the very beginning of psychosomatic existence’. He in fact defines the psyche as ‘the imaginative elaboration of somatic parts, feelings and functions, that is, of physical aliveness … [the] interrelating of the psyche with the soma constitutes an early phase of individual development.’ Winnicott goes on, in a clinical illustration, to describe somatic phenomena as a form of ‘acting out’. (Winnicott, 1949)

In attempting to develop meaning in the psychic-somatic pain of the patient who is the subject of my paper, I have found both Fordham’s theory of de-integration and reintegration and Bion’s theory of the shifts in functioning between Alpha- and Beta-elements to be exceptionally useful. Briefly, Fordham’s theory considers that the theoretical ‘primary self’, with its archetypal composition originally integrated and undifferentiated ‘de-integrates’ in the course of the experience of an object, whether intra- or extra-uterine. For example, the breast feed normally constitutes a de-integrative experience in which the contents of the baby are brought to bear on his experience of the outer world, and growth and development take place within him. He then re-integrates, for example, through sleep. Thus the ego is gradually built upon. The experience is pervaded with the quality of the wholeness of the self. (Fordham, 1957, 1985) This can be compared with and contrasted with Bion’s concept of the container-contained experience for the baby. In intimate relation with another who ‘digests’ the baby’s physical-emotional experiences and gives them back to him in a form that enables thought, his capacity for transforming the unthinkable, or what Bion called Beta-elements, into imagery or phantasy (Alphaelements in Bion’s term) can begin to develop. The process that takes place is called containment. The mother or caretaker gives each experience a name, a shape – meaning, as it were, and thus give rise to reverie, dream-life and thought, or Alpha-function. Present-day attachment theorists such as Fonagy describe this relation as one in which the mother ‘mentalizes’ the baby’s somatic states and the baby internalizes her reflective functioning. As Bion succinctly put it, the infant takes in the mother’s capacity for thinking. He termed this the introjection of a ‘thinking breast’. This draws on the Kleinian concept that for the baby the experience of the moment, good, bad, some part of the body, is the whole world, totality; ‘part-object’ psychology, as it is termed. Bion stated that one reason for the long period of the baby’s dependency on its mother is so that he can establish this relationship with a thinking breast inside himself. (Bion, 1979)

To my mind, when both of these systems, Bion’s container/contained and Fordham’s de-integration/re-integration, are understood to be in potential relation, that is when the baby feels that he is contained and thought about in the mother’s mind and the emotional transformation of his unthinkable experiences begins to occur, then, as I see it, de- integration of the archetypal primary self may proceed.

The baby attempts to develop knowledge of his inner and outer worlds when internal and external conditions are favourable enough. Contrariwise, when the psychic reality is too disturbing, destructive attacks on knowledge and understanding may take place. It is then that the baby’s undigested experiences cannot be thought about and learned from. They remain unsuitable for thought, or they remain as Beta-elements, in Bion’s language, they are suitable only for evacuation, and it is then that I believe that the ebb and flow of de-integration- reintegration fails.

Meltzer, writing of what he calls the circular orbit of Bion’s ‘creative flight of imagination’ over thirty years with regard to the model of the mind as an apparatus of thought, starts with Bion’s discovery of mindlessness and ends ‘with [Bion’s] suggestion that prenatal parts of the personality tend to become split off at the caesura of birth’ and to remain in a state of primitive social organization without the means of mental representation. (Meltzer, 1964, Bion, 1962b) This appears to be what Andre Green calls ‘madness’ as opposed to psychosis, a differentiation between primitive mental states and pathological defence organization.

These concepts of mindlessness and of the proto-mental apparatus are strongly reminiscent of Jung’s conceptualization that the archetypes have a psychoid pole that is outside mind, like a spectrum of light at its infrared and ultra-violet ends (Jung, CW 9, i) Meltzer states that the operations of the ‘proto-mental apparatus … correspond closely to Freud’s description of Primary Process’ and the prescription that ‘in the first instance the ego is a body-ego’.

Infant Observation

Consider, if you will, this evocative vignette, which the infant observation seminar group thought about in some depth.

Jim is a baby who has suffered from eczema, sometimes generalized over much of his body, asthmatic symptoms, and skin rashes. These symptoms have seemed worse at times of stress, such as at the onset of weaning, which took place around thirty-two weeks. There have, moreover, been a number of unresolved anxieties for the mother and the family throughout this first year of his life. Looking back over the observations, the group and I had wondered and commented on the mother-infant relationship as follows: ‘nothing seems to go to completion … breathless emotional life … no chance for the thought to form … manic denial … manic excitement … things are rattled out of his mind … shaken out … bounced out … can’t face Mother … manic muscularity.’ That was at thirty to thirty two weeks, whilst his mother’s emotional state was in doubt and weaning was progressing rapidly. Yet there were also such comments as ‘thought’ and ‘reflec tion in the absence of the mother.’

At one year and three weeks, the observer noted the following:

‘Jim seemed quite cheerful when I got there and came out to say “Hello.” Mum said they had had an awful night with Jim and Natalie, his older sister, because they both had bad colds. She’d been up and down all night and Jim had been in their bed. They had had no sleep. I sat down on the sofa and Jim started to give me things. He put two plastic cups into my hand and then I had to give them back. Then after a few minutes doing this he gave me a large, many-handled rattle and left this with me while he went off into the kitchen to see Mum who was making tea. I followed. He stood up clinging to her legs, trying to get her attention. She was aware of him but busy trying to get the tea and his drink so she talked to him but asked him to wait. He saw his drink and became more and more persistent for attention as if wanting to be picked up and crying very loudly. The drinks were ready and taken back into the living room. Mum then picked Jim up and put him on her knee ready to feed him. She gave him two spoonfuls of drink but he was not to be consoled and the crying went on for twenty minutes during the scene that I shall now describe.

‘He didn’t seem able to get comfortable in any position. He struggled out of her arms onto the floor but that was no good. As soon as he was there he wanted to get back onto her knee. Mother talked to him and was very patient, soothing him with her words and stroking his hair. He was inconsolable and seemed to be distressed and angry in the way he cried. Mother began to speculate on whether he’d got earache and said she would take him to the doctor that afternoon. At one point he stopped briefly when I went out of the room to fetch a tissue at Mother’s request but started again when I returned. I tried leaving the room again later but this time it made no difference at all.

“Eventually he calmed down, lying sobbing quietly on the floor with June stroking his back. He sat up and Mum tried him with a spoon of drink. He turned his head away emphatically. He crawled over towards Mum’s tea and when she said “No” quite mildly he broke into a storm of crying again, unusually for him, in a highly touchy state.

“Mum picked him up and sat him on her knee with some toys –a teddy, two Fisher-Price men, two cups that fitted inside each other – he gradually got involved. Mum put the little men on her fingers and danced them in the air – Jim liked that. He also got the teddy on his knee and leaned into it. Down on the floor now he played with the cups and the little men. He put the little men inside one of the cups and gave it to me. He would either take it back or in the giving the men would fall out and he’d give them back to me again. He did this several times. It was during this time that he calmed down. He then put the cups inside each other and gave them to Mum and me. Then he put the smaller cup inside the other but upside down and stood one of the figures on top. This absorbed playing on the floor lasted for about ten minutes.

“The doorbell rang. A man had come to deliver something. Jim crawled over to the washing but wasn’t very interested and soon came back to where June and I were sitting. He picked up my cup and threw it really hard at my knee. It hurt! After I’d recovered he picked up the cup again and offered it to me. There was another point after this when Mum said “No” to him again but I can’t remember why. I thought he was going to cry again but he didn’t. There was a complex look on his face as if he was thinking and there were many different feelings going on.

“In the last phase of the observation he went over to the toy box and seemed completely recovered. He rummaged in it taking things out and examining them as I’ve seen him do many times in the past, as if nothing had happened.’


Jim’s mother had perhaps been seconds off in her attending to him, and his inability to find a mother who could make a sincerely extraordinary effort to receive his angry de-integration led to a disintegration. In the event, his mother eventually resorted to distracting him rather than continuing to try to contain his distress with empathic actions and words. June thought of Jim’s distress, but in bodily terms, an earache, and although this is a reflection on his state of mind, it was difficult for her to understand at that moment her baby’s dependency on her and his need for her to have responded sooner, and thus to hold in mind his frustration. It appeared that the baby could not find a true container for his rage and he evacuated his feeling in the form of what could be described in Bion’s term as a Beta-element, the hitting of the observer with a cup. His rage was not digested.

Meltzer wrote, ‘When an emotional experience impinges on the mind its disparate elements of sense data, internal and external, exist in a state of Beta-elements which must be worked upon by Alpha-function to produce Alpha-elements from which symbols may be formed and organised into the narrative of dream-thoughts as the first step in thinking. To whatever extent this transformation fails, the residue of Beta-elements must be dealt with as “accretions of stimuli”, which can neither be used nor stored as memory. The means of their evacuation are several, one of which is the “beta-screen” of pseudo- communication of non-sense. … But other means of evacuation of beta-elements may also be discovered amongst which the recourse to the proto-mental apparatus is in evidence, namely through regression to group mentality and its near-ally, somatic innervations. [Italics mine.] In either instance the central issue is the loss of mental function at the level of symbol formation and the creation of meaning and significance for the emotional experience’. (Meltzer, 1964)

The Patient

I shall call my patient Steven. For confidentiality, his details are heavily disguised. At the time he entered five-day-a-week analysis he was a married man of thirty-three. He was a highly educated scientist who was not working, having suffered some form of breakdown when he went to a wealthy developed foreign country (connected with his mother’s country of origin) to investigate a work opportunity. His work concerned the eco-systems, politics and economics of underdeveloped third-world countries. He told me that he had severe anxieties about eating with other people, especially with colleagues, and in expensive restaurants or at dinner parties. He frequently suffered dizziness, near-fainting and chronic abdominal pain with diarrhoea, alternating with constipation. He described fears of going into theatres and cinemas, distrust of new people, and he felt that he was not getting on in life. He knew that his symptoms were only part of the picture, and that he was deeply disturbed. He felt depressed and hopeless.

I will try to give you a sense of the atmosphere of much of his analysis, which lasted many years. I will show some of the transformations that took place from the confused states in which he mainly lived when he began his analysis into the beginnings of the capacity for reflectiveness and symbolization and how they developed through the analytic relationship. Much of what took place could be described as the emotional experiences of very early infancy, as you will discover. In the transference/counter-transference relationship, my patient seemed initially to have lacked the experience of his emotional life being digested and made sense of.

Steven came into analysis with a strong pre-formed transference, soliciting my help with an admixture of infantile dependency and suspicion. He soon became intensely dependent on his sessions with me, in keeping with a general sense of urgency and intensity that he had conveyed from the outset. He was unable to bear the breaks from Friday to Monday, and after difficult months of my working to contain his anxiety we agreed to meet six days a week. It became necessary to arrange for him to telephone me every night at a certain time for a few minutes, moreover. This need diminished in importance and stopped after about a year followed soon afterward by a return to five sessions. He was tearful and openly weeping throughout every session as he mostly reported his version of his history. I listened, contained the affect, thought, and attempted to elucidate his experience.

In a long initial phase of his analysis Steven manifested confusion between inner and outer life. He showed confusion between the parts of the body and their functions of the inner figures of his dream and phantasy life. He regularly confused the past and the present.

Unusually, for such an early phase of analysis, he moved quickly into an intense and complex transference. He feared and felt that his childhood relations with his parents were unquestionably occurring between us. He was increasingly to express this in terms that seemed to entail very little censoring of his unconscious bodily impulses and phantasies. For instance, he thought that he was using me as a toilet, a cushion, a doormat, into or onto which he placed his distress, and he expressed a strong fear of being fed or penetrated by a part of my body that literally contained poison or sexual excitement. At the same time he expressed the wish to hold my hand or to be held in my arms or lap – just held and not fed or otherwise, as he called it, “penetrated”, even by my eyes. He was deeply distressed by his ever- present feeling that my words had no intrinsic value to him but in his mind my lap was a soft, concave place of comfort. At the same time, his phantasy was that there was a third thing, a hard intruder in the desired soft lap. The part of me in which he longed to be was therefore both desirable and dangerous. He also felt that the light coming in from outside was sharp and penetrating. He felt that it was shitty and messy inside him, feelings that were centred alternately on his head, his heart, his guts and his genitals. He feared that these conditions or parts of him would enter me and damage me, or I would quickly force them back into him unchanged or in a worse form, for the purpose of mocking or attacking him.

As you might imagine, a patient with such concrete thinking, who develops such a rapid and tempestuous transference relation, with persecutory ideas that were apparently impossible to shift, presents specific technical and counter-transference questions. The customary verbal interchange is fraught with difficulty. Words are concrete objects, things-in-themselves, feared, hated, loved, erotic, even. Yet the non-verbal aspects of the relationship including all of the analyst’s behaviour are equally filled with a penumbra of meanings, often impossible or too vast to encompass or interpret. It inevitably evokes responses in the counter-transference that make working with it particularly disorientating and demanding.

This may be illustrated as follows: Steven reported that he had had colic when he was breast-fed in his infancy. He felt that he damaged the analytic “food”, which he often experienced to be me, literally, as food. He was troubled by the fact that real food was actually turned into shit. His thinking was replete with references to the nature of food – what is in the food? What part of the animal’s body has it come from? Is it wholesome or bad? etc. He thought obsessively about the timing, atmosphere and general meaning of the feeding experience from the point of view of the feeder and the fed (e.g., the waiter and the chef in the restaurant, what their relation was to the customer, whether they mocked or ridiculed, spat, urinated or ejaculated into the food, how much they wanted to please, to hover over and watch every move, etc.). He was frequently concerned that my room showed signs of flaws or damage, which represented to him damage in my “insides.” In his mind he may have inflicted this damage or not, but if I were damaged, I might be unable to care for him. He was above all concerned to have my undivided attention.

He thought that I might be quite antagonistic to him, or at the very least, that my mind was filled with what he thought of as my “other babies” – my family and my other patients. Their presence, as he felt it, was a constant irritant to him, and he wished to drive them out of my head. In that regard, his loud sobs were often heard and commented on by various other patients who had arrived in the waiting room for their session and could hear them, some distance away, or by another analyst and her patient in a consulting room on another floor. Weekend separations were for a long time nearly intolerable and the Saturday and Monday sessions were especially replete with material pertaining to the separation.

He did not know what to do with himself and felt unable to think, bewildered, lost and at sea. He took to his bed and pulled all the covers over his head to sleep for long periods of time between sessions.

You will see that a significant proportion of the analytic sessions contained physical events or highly concrete use of language, interspersed with verbal communication that seemed to have clearer mental links, meaning and feeling. I noted that words or thoughts that expressed emotional meaning and conflict were often incomprehensible, or else they were stripped of their meaning and turned into ‘things-inthemselves.’ As an example, he observed that this was a Friday again, then there was a weekend, then after the next Friday there was the long summer break. I said that his hand was on his stomach. He replied that it was also on his heart, and that “it felt” – not “I feel” – like there is something in his heart … quickly adding that maybe it was just a place to put his arm rather than dangling it over the edge of the couch. At the same time Steven would consistently, tearfully, lament that words did not have much meaning to him and that he wished I could actually come on the couch and hold him, for that would prove to him I was real, that I was really there, and it would furthermore be a tangible acknowledgement that I liked and loved him. He found the differences between us virtually unbearable. For example, he contrasted the rarefied environment of the analyst’s chair in which I sat with the painful environment of the couch, his domain. He felt that our being in two such different worlds meant that I could never understand the physical events which take place in his body nor could he know anything about those which take place in mine, apart from the information his eyes, nose and ears sometimes gave him. In these, he showed keen and unflagging interest, such as if I burped, smelled of garlic or had a Band-Aid or a suntan, and how I breathed or sighed.

He frequently expressed phantasies in relation to my body and his body. These often had to do with his physically, concretely wanting to be known, understood and attended to, including his wanting to be fed to exactly the right extent and for exactly the right motives, by a reliable and “safe” object who would not intrude or leave him, and who would not be too near nor too far. He equally strongly feared all of this. The conflict between the two sides led to his massive use of the defence of projective identification with a phantasy of entering and controlling me, as opposed to learning about me and trying to know me as I am. That is to say that he was in competition with me for me. He needed to take refuge, in phantasy, “inside” me when, as was occurring more frequently, the stress of life outside me, in psychic reality, was too great. But the inside of me was a far more threatening place in which to live, as he could not think for himself there and he was in fact far more vulnerable to my internal processes, and in his mind I was to his as well. At the very least, in this internal world he lost parts of himself or he felt I stole them from him. Worse, in that situation he was not an individual for me to know at all, not distinguishable from any other “patient-babies”. In the other aspects of his life the patient often did not know what to do with himself, could not make decisions and felt “lost” until the next session.

He was preoccupied with his relations to both the outside and the inside of me. At a primitive level he wished to know my inside out of fear of what was there. This is ‘knowing’ in a very different sense than the Bion, in which the ‘K link’, the highly developed wish to know one’s object, is out of concern and interest in the other. This ‘knowing’ is more out of wariness, like one animal watching the movements of another one. Yet the difficulty in his wanting to know the contents of my mind – which corresponded to life outside my body, in his phantasy – was, he asserted, that my mind was impenetrable and unknowable, or at least vastly more difficult to apprehend than my body. Contemplating it made him painfully aware of our being different and separate. He wanted, temporarily, he said, to make us the same by my cuddling him or letting him put his head in my lap. On the other hand, he said if I were to agree to this, to permit him to go “inside” me and be “together” with me, in his inner reality, it would, in his mind, evoke uncontrollable responses from me and would damage or destroy my capacity to think. Alternatively, the request might make me distance myself even further from him. I might despise and reject him. These patterns represented the extreme behaviour, in his mind, of a soft and effusive unthinking mother-me who was not balanced by the firm, thinking father-me, and vice versa. If he were able to destroy the links between his mother and father in inner life, their coniunctio, as it were, he would have the worst (archetypal) qualities of each individually, the one unmodified by the other. In his words, he would have a sloppy, anxious, guilty and sexually excited, unthinking mother without an organizing father-mind, or a sharp, rejecting father-mind without tenderness or understanding.

All of this is in fact what his phantasy and his dream life showed throughout a long period of his analysis. He would hold his abdomen, complaining very often about aches in the bowels, and report that he had had cramps and diarrhoea that morning before coming. He generally described this as having been accompanied by an erection on waking and whilst going to the toilet. He wished the erection could last until he saw me, as it connected me with him. He invariably arrived in time to use the toilet before his session if it was necessary, and frequently mentioned it if he had defecated, telling me of his anxiety, for instance, about defecating into me and of farting in the session.

He said that his insides did not work well, and he felt that mine unquestionably worked well. The word “work” was meaningful, too, in terms of the work that he could not now bring himself to do in his professional life. He compared himself with me in my ability to work, which he both wanted to break down and feared breaking down if he could bring me onto the couch with him and stop me thinking. For me to be able to think, he argued, was to penetrate into his interior, which a part of him did not want me to know about. My knowledge meant power to control him and to damage him, by being able to put inside him anything I chose. Thus the interior of the body is vulnerable to saturation and thence control by projections from the interior of the other – milk, in his feeding phantasy I mentioned earlier – which could be mixed with, and could have the power of faeces or sexual substances and feelings to take over his internal environment. The difficulty, I might add in passing, in my interpreting this projection of his wish to control me and to arouse in me the feelings for him that he wants me to feel – the motives to care for him, to function for him, to become dependent on him and to be unable to leave him – was that his acceptance of the understanding itself would change him and empower me. However this fear was in some dynamic relation with the part of him that prompted him continually to remind me that he wanted me to be able to think in order to control my feeling responses to him. He was throughout trying to find good food-meaning and caring in my words and to grow and develop.

Eventually Steven became painfully aware of his own wish to be in control of every aspect of my physical and mental functioning in myriad ways, which he would express explicitly.

The above picture of some of the atmosphere in the room pertains to my patient’s phantasied attacks upon body boundaries that gave rise to his states of mind through much of his analysis and to his difficulties in being-in-the-world. However, I am mindful of the patient’s belief that his viewpoint cannot be truly represented, as he commented to me when I requested his permission to write about him. One can only describe these seeming bodily states of anxiety which provoked, as might be expected, a highly-charged atmosphere in our work, one filled with such strong and urgent projections, very often communicated under dire pressure and in confusion, physical in phantasy, as to actually threaten my ability, at times, to maintain a necessary equilibrium between thinking and feeling in myself and to retain my analytic attitude.

It has been observed that ‘by stressing the origin of psychosomatic phenomena outside the sphere of symbol formation and thought, there is an important distinction from other phenomena which involve either body sensations or somatic innervations such as conversion, hypochondria and somatic delusions … we cannot expect to deal with psycho-somatic phenomena by interpretation of content whether they present as disease entities or as transient events in the course of analysis. We must set ourselves an entirely different task, namely that of discovering the emotional experience which the patient is unable to dream about and to do his dreaming for him. One implication is quite clear, that we cannot perform this function intellectually; it requires an unusual degree of identification with the patient, an unusual depth of reverie in the session, and an unusual degree of tolerance of feeling mad oneself. (Meltzer, 1964).

Clinical Material

I have written an account of some of the interaction that took place in the seventh year of this man’s analysis and to try to look at some of Steven’s ‘bodily states of anxiety’ in the light of discovering the emotional experience which the patient is unable to dream about.

These fragments express Steven’s dread of allowing meaning into the persistent psycho-somatic experiences of earliest infancy, when meaning invokes the pain and suffering of terrifying separation, envy, jealousy and destructiveness within and without, from himself towards the other, from the other towards him, and from himself towards himself. This includes aesthetic pain, explicit in the last fragment and appearing throughout the patient’s material as the beauty he believes to exist in me: the beauty of my understanding or of the analytic experience, or, usually in disguise, his own beauty. In this latter, he was expressing his wish to retreat from the pain of the beauty of a relation between two people by destroying the meaning of the words that link and separate them. He is afraid of losing parts of himself – body parts and feelings, faeces, urine, farts – into a void, unreceived, unheard, where they will vastly expand and be re-projected, rather than given meaning, or into a trap, a claustrum (Meltzer, 1964), where he will be trapped with them. The material is omitted in this paper for reasons of length and can be found in the fuller version on the CD.

In Psychological Types, first published in 1920, Jung wrote, ‘As the essence of empathy is the projection of subjective contents it follows that the preceding unconscious act must be the opposite – a neutralizing of the object that renders it inoperative. In this way the object is emptied, so to speak, of its spontaneous activity, and thus made a suitable receptacle for subjective contents. The empathizing subject wants to feel his own life in the object; hence the independence of the object and the difference between it and the subject must not be too great. As a result of the unconscious act that precedes empathy, the sovereignty of the object is de-potentiated … because the subject immediately gains ascendancy over the object. This can only happen unconsciously, through an unconscious fantasy that either devalues and de-potentiates the object or enhances the value and importance of the subject. Only in this way can that difference of potential arise which empathy needs in order to convey subjective contents into the object. (Jung, CW 6, §491)

Jung’s description is strikingly close to what, many years later, Klein developed as her concept of Projective Identification, laying the foundation stone of a hugely important area of understanding.

‘In her 1946 paper Melanie Klein described the operation of an omnipotent phantasy of intrusion inside the body and mind of another (external) person, producing a form of narcissistic identification and a corresponding alienation from one’s true identity. Work by her followers in subsequent years traced a wide range of pathological phenomena to this mechanism, including claustrophobia, agoraphobia, hypochondria, manic-depressive states, disturbances of thought and judgment, certain psychotic confusional states; as well as demonstrat ing that the mechanism also operated with internal objects.’ (Meltzer, 1982)

One can discuss the analytic experience with this patient from a number of theoretical angles, that is, starting with the material (omitted from this account for lack of space) and constructing the theories. There are, for example, important considerations pertaining to the essentially psychotic quality of his anxieties and his defences, notably anxieties to do with abandonment or annihilation and the defence of intrusive identification. There is the relative inhibition of symbol formation with consequent stunting of ego development in social areas whilst overt intellectual functioning proceeded apparently unimpaired.

I think it is very important to reflect on the way one works with all of this. What is the means by which meaning can emerge and the shift can take place from the predominantly bodily experiencing of emotional conflict towards the capacity for reflectiveness? Bion’s schema of container-contained giving meaning to Steven’s projections and enabling Beta-elements to give way to Alpha function (Bion, 1979) is an invaluable model that one can see to be operating, facilitating de-integrative and re-integrative processes and slowly diminishing the extreme and pathological defences of splitting and intrusive identification in favour of integration and the capacity for concern. I believe that change takes place in living through the emotional experience of meaning within the I-thou relationship itself. Jung frequently counselled that the personality of the analyst is central to the process. This is, one hopes, anything but an exercise in the analyst’s narcissistic self-idealization. It is a situation essentially unlike any other, where the inner world of great meaning comes alive and is played out, where ‘something is always happening’ in the relationship. (Joseph, in Proner, 2003)

There remain, however, serious and important questions about the somatization, for of course my exposition is far from definitive. What else can we say about the shift toward and away from bodily experiences as an alternative to dreaming and emotionally meaningful phantasy in general? It is of great relevance that this patient produced any amount of what I would call ‘inside’ material, which pertains to a life inside the consulting room, or inside my body, but for a very long time he said little or nothing of his external life – his marriage, his actual sexual life (and fantasies) outside the consulting room, his present work experiences, his family and social relationships – except to give me the impression he was always and is still, what his mother described as ‘a Puritan’. He treated the analytic situation as an enclosed place, which was not to be corrupted by experiences outside of us. What are the implications for treatment in such a ‘situation’? Does the analyst ever collude with the painful longings for a seductively sensu ous physical experience of being inside something together, shutting the curtain, holding his hand and holding him when importuned, or does the analyst behave ‘cruelly’ from the point of view of such a patient by remaining in the analyst’s chair and analyzing the pain and the frustration of the outside-one-another relationship? The answer to that, I think, must reside in thinking about where and under what conditions true development takes place, not mock introjection or swallowing-whole, or adhesiveness – and how excessive psychic pain, on the one hand, or gratification of the patient’s requests, on the other, interfere with the development of the ability to live on the outside, and to take the other in.

As for the question of the relation between bodily experiences and thought, I should like to mention briefly two fanciful conceptions of the relationship between the mental fact and the somatic fact.

The first is a striking theory of psychosomatic illness and self- destruction worked out by the Jungian Leopold Stein, in a paper he published in 1967 called ‘Introducing not-self’. (Stein, 1967) He suggests that the psyche-soma may have analogues to the body’s immunological system, wherein what is self and what is not-self can be ‘recognized, ’ as it were, and analogous mechanisms of defence, protection and destruction can be postulated. Moreover, just as the body can mistake its own tissues, if damaged, to be foreign intruders to be destroyed, so too can the mind, he speculates. I made just this point in two papers on envy of oneself. (Proner 1986 & 1988) Stein claimed that ‘the archetypes in the dynamic self are analogous to antibodies which aim at destroying what is, or is regarded to be, not-self, however misguided this attitude may be.’ He saw this ‘as a drastic repudiation of the notion of the archetype of order’. He went on to think about what enables the organism to recognize what is self and what is not-self, about stearic shapes of mirror images, about stereo-chemical fit, about identity and complementarity, about Fordham’s theory of de-integration and his belief (which he eventually discarded) that the infant is looking for an exact fit, and that in immunity the object that does not fit exactly would be an antigen or a toxin.

The second of the two fanciful conceptions is Bion’s so-called “imaginative conjecture”, which goes something like this:

‘Suppose that the primitive … level of the mind, organised as an “establishment”, if strong enough, may have direct access to those complex humeral, haematological and healing processes which ordinarily protect our bodies from the various noxious events which threaten them. Suppose further that this “establishment” treats these processes … as a “privilege”, which it dispenses with an open hand to the “obedient” self. Suppose further that in order to survive in the internal and external worlds it is necessary for the thinking parts of the personality to acquiesce in the rules of the two ‘establishments’, internal and external, and to make for itself, quietly, as it were, elbow-room in which to carry out the passionate interests and relationships that are at the heart of the life-in-the-mind. If at some point an enlargement of this elbowroom were to take place which ran counter to the requirements of the internal “establishment”, might the individual find himself in a kind of legal-political trouble exactly analogous to that pursuant to a “breach-of-the-peace” or “anti-State activity” in the outside world? Might the thinking parts of the personality find that the privilege of immunological products had been cancelled and that everyday processes of defence against bodily enemies, external ones like bacteria, for instance, or internal enemies like primitive cell mutations, no longer operated? It would be similar to one’s water or electricity being cut off. The house would soon become uninhabitable unless archaic modes of coping could be revived. But where would one find a well or an unpolluted river? Whose wood could one scavenge by hook or by crook’? (Meltzer, 1982)

May I now put elements of these two imaginative conjectures together? My patient’s desire for ‘more elbow-room for his passionate interests and relationships’ surely includes the passionate desire to know that he is acknowledged and understood as well as loved and liked (he once asked me directly if I felt those towards him) in a relation with just the right ‘stearic shape’ or fit for him. He seems to experience any person or anything that does not recognize his exact needs as ‘not-self’ in Stein’s language. What is the aetiology of his disturbance? Perhaps his mother had a great deal of difficulty in relating to and recognizing her baby as he was and in meeting his needs at an early stage. It is known that at the time of his birth she was grieving for a four-year-old son who had died several years before. She was from an extremely wealthy family in another country and she came to England as a foreigner without family, living in modest circumstances. My patient’s father was a disabled man who was described as ineffectual. We may also think about how much of Steven’s ‘passion’ stems from his innate personality; was he was a baby who was inordinately sensitive to impingement or frustration? In my view, there may have been a combination of both factors. In the transference/counter-transference relationship his struggle for a ‘fit’ or ‘match’ seemed all-important, and the experience of non-fit, catastrophic. In the counter-transference, I was continually struggling with Steven’s projection that I could be a narcissistic mother who thinks first of her own needs and expects her baby to adapt to her. In borderline phenomena, the analyst is often made into the baby who feels excluded or neglected while the patient takes the position of a narcissistic parental figure. Is his sensitivity and the intensity of his needs, along with the fear of their remaining permanently un-met and the anxiety generated by these, just what may be meant by ‘sufficient provocation for removing the privilege of immunity from self-attack’? And if this is so, what, indeed, can be the power of words as enemies of the totalitarian ‘establishment’ to uncover the subversion, which I would see as the retreat from relatedness to somatic, concrete and ‘omnipotent’ states of mind as the extreme measures of a baby besieged by so called not-self experience? We can see that words were both the enemy, as they removed the ‘direct experience’, and the indispensable factor in the growth of thought, symbolization and independence.

The power of words was stressed by Vaclav Havel in an essay on the occasion of his accepting a German peace prize between the time when he was an enemy of the state and his becoming President of his country. It was a time when words could still land a citizen in prison. His work was entitled ‘A Word About Words’. It is about the capacity for representation, as distinct from action, as much as it is about words proper. When I first read his essay, I was tremendously struck by the importance of the ideas to us in our profession. He wrote, “Words can be said to be the very source of our being, and in fact the very substance of the cosmic life form we call man. Spirit, the human soul, our self-awareness, our ability to generalize and think in concepts, to perceive the world as the world (and not just our locality), and lastly, our capacity for knowing that we will die – and living in spite of that knowledge: surely all these are mediated or actually created by words? It is not my intention to speak solely about the incredible importance that unfettered words assume in totalitarian conditions … the point I am trying to make is that words are a mysterious, ambiguous, ambivalent, and perfidious phenomenon. They can be rays of light in a realm of darkness, as Belinsky once described Ostrovsky’s Storm. They can equally be lethal arrows. Worst of all they can be one or the other. They can even be both at once!” (Havel, 1989)


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