33 Chapters
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Chapter Six: Inés: Bleeding Lips and Tongue when Separation Occurs

Rosenfeld, David Karnac Books ePub

This patient's psychosomatic clinical picture exemplifies Winnicott's hypothesis of undifferentiation or total non-separation between the baby's lips and the breast, in the sense that each separation or withdrawal of the mother, in this case the therapist who is going away on vacation, causes her to react with her body as if when the breast goes away, it would tear off part of her lips and tongue.

This is body language, without words, in which bleeding wounds are produced in her lips, tongue, and the mucous membrane of the palate. The baby's sensitivity to separations is described in this way by Winnicott (1971). This was also elaborated by F. Tustin in her works with autistic children and the way they experience separations (1986).

To understand better the great sensibility of this patient Inés each time she lost contact with her analyst, we can look to Winnicott to express better what happens to the infantile part of the patient. Winnicott (1971) described the child's possible responses to his mother's absence while she is away, suggesting that for the child or the baby the mother is dead. From the point of view of the child, this is what dead means. It is a matter of days or hours or minutes. Before the limit is reached the mother is still alive; after this limit is overstepped she is dead. In between is a precious moment of anger but this is quickly lost or perhaps never experienced, always potential and carrying fear of violence.

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Chapter Five: The Boy who Said that Bats were Flying out of his Cheeks

Rosenfeld, David Karnac Books ePub

I interviewed patients at the Milwaukee, Wisconsin Children's Hospital. One of these cases was a young man about twenty years old who hallucinated that bats flew out of his cheeks. His lower limbs were also paralysed and he said he had cancer.

In the interview I was accompanied by neurosurgery and psychopathology teams. When I asked the patient about his family, he said he has a little daughter of one year old. He also told me that when he was small, a year after his birth, his mother died.

When I asked him why he is in the hospital, he answered that it must be because of the bats that fly out of his cheeks and the cancer that paralyses his feet.

Later, I asked him what his mother died of, and he answered that she died of lupus. I asked him if he knows what this illness is like and what it causes on the face and cheeks of people who have it. He said he does, that it causes marks on the face, and on the body, lesions.

A colleague asked him how he was able to get through his mother's absence, and he answered that he is very religious. They asked him if he knew where his dead mother might be, and he answered that she is in Heaven.

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8. Hypochondria, somatic delusion, and body image

Rosenfeld, David Karnac Books ePub

Knowledge in the psychological field is different from that in the physical sciences, in that it does not consist of discovering physical objects and processes that are already in existence to be uncovered. Rather, it is made of detailed observation of, combined with empathic responsiveness to, another person’s states, so that a construction which has sufficient consonance with the nature of those states can be formed, making it possible to describe them to other people who have had something like the same experiences. Thus, those readers who have not had deep experiences with psychotic children may have found this a somewhat incomprehensible book, for we have been immersed in states which are not part of everyday experience.

[Frances Tustin, 1981]



n this chapter I attempt to describe the various clinical ways in which hypochondriac pictures become manifest in psychoanalytic practice. It is not my purpose to create new entities or abstract terminology, but rather to offer a description that is mainly based on the clinical experience of the variations a hypochondriac picture may present; the realization that different dynamics prevail in each of them may prove useful for their technical and therapeutic handling in psychoanalytic practice. The mechanisms underlying hypochondria are predominant modes of functioning, which does not imply they never change: they may change, become altered, and alternate with others. What I want to stress is that there is a prevailing dynamics, as well as its relationship with generic-developmental levels. Likewise, I discuss the conceptions of body scheme predominant in each type of hypochondria.

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1. Introduction

Rosenfeld, David Karnac Books ePub


In this book, I develop models and hypotheses about the mech anisms of the origin of language and the self, along the following lines:

1. A return to Freud for a theoretical review of autistic mechanisms

2. The concept of self

3. The possible disappearance of introjections

4. The concept of body image

5. Autistic encapsulation to achieve preservation

6. Treatment technique

7. Four years of flming

In his “Project for a Scientifc Psychology”, Freud (1950 [1895]) describes how the frst contact of the child with the outside world—as in the case of a baby at his mother’s breast—is of a sens ory nature. As I show below, the frst hallucination is a repetition of this early sensory feeling: the mouth on the breast.

When we watch a baby moving his mouth, imagining he is suckling at the breast, this hallucina-tion—“the frst psychological mechanism”—is also a “communication”. The communication will only be useful if it is interpreted—in other words, if the message is received and understood by the mother.

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Rosenfeld, David Karnac Books PDF




he following fragments of clinical material pertain to

Pierre, at a time three years earlier. In it, we are able to observe the way in which I intervene and interpret the transference in a post-operatory psychosis rooted mainly in fantasies about the primitive psychotic body image. It is worth pointing out that the tumour for which he was operated turned out to be encapsulated and benign—a glioma—and it was entirely removed.

It is my intention to show the analyst’s role in the transference, and also to highlight a rich and clear material on the fantasies that the patient Pierre reveals to us regarding the image and fantasies about his body, especially those referring to his body fluids to which we refer as the primitive body scheme or psychotic body image.

The first unexpected incident, which startled neurologists, surgeons, and me, was a post-surgical psychotic episode—a delirium in which the patient affirmed with conviction that liquids were being extracted from his body. These included the encephalic/spinal fluid, blood, semen, and urine as vital fluids.

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