Psychic Skin Research Articles

Petrification, Chaos, Primitive Triangulation and the Therapeutic Power of Game-Play

ABSTRACT This article discusses the use of traditional structured games such as Monopoly, Draughts, War and UNO, in psychoanalytic psychotherapy with children in severely disturbed states of mind. The author focuses on two opposite poles of disturbance: states of psychic petrification, typical of children on the Autism spectrum, and states of chaos, typical of children in psychotic states of mind. It is suggested that these structured games can serve as a vehicle for what Alvarez terms the language of “fatherese,” a call to psychic growth, structuring, and communication with the outside world. Drawing on Houziel’s and Rhode’s thinking on the bisexuality of the psychic skin, it is proposed that structured games combine male elements of structure and solidity with female elements of emotion, uncertainty, and porosity, thereby enabling work on a primitive level of triangularity. Two clinical examples are presented: the first where the therapist introduced a process of negotiation into a game of Monopoly with a child adhesively addicted to petrified game-play; the second where the therapist initiated a game of SET to introduce psychic structuring and a space to think. These clinical examples are analyzed in terms of Bion’s concepts of the Establishment and the Messianic and Amir’s concepts of psychic tonality and atonality.

‘Psychische huid’ bij autisme en narcisme: een psychoanalytisch perspectief

Autism and narcissism in adulthood can look similar, complicating psychiatric classification. Using the psychoanalytic model of the psychic skin, together with clinical examples, an attempt will be made to map differences between the two phenomena which may initiate phenomenological and psychodynamic research and sharpen differential diagnosis.

The psychic skin between individual and collective states of mind in trauma

This article attempts to develop an argument about a relationship between the individual intra-psychic functioning and the social and political life in trauma. This relationship, it is argued, is mediated by the skin and sensations related to touch and the imagination of it. The deepest transformations of the individual self and a group’s political and social life seem to go through a rearrangement of the psychic skin as a means of development. Three examples show how the psychic skin operates at the point of intersection between the individual and group states of mind reshaping the individual self and group identity. One example is about the relationship between the fascist architecture in the city of Rome and the 1930s fascist political project of shaping a ‘New Man’; another is my understanding of the post-traumatic suffering and changes of my refugee patients who have survived torture, which is a trauma inflicted by a collective; and third, it is an hypothesis of the role which the Western Wall in Jerusalem had in reshaping Israeli identities on the backdrop of traumatic history and wider tensions of two peoples on that disputed territory.

Displacement trauma: complex states of personal, collective and intergenerational fragmentation and their intergenerational transmission

Originally presented at the Journal's one day conference entitled 'Displacement: Contemporary Traumatic Experience' held in London in November 2019, this paper expands on the author's theory of the implicit psychological organizing gestalt, an associated pattern of psychic functions which operate in an integrated way to simultaneously structure and organize our experience of self-cohesion and self-continuity. The gestalt, which implicitly links the formation of psychic skin, body image, cultural skin and both personal and cultural identity with place, functions as an emergent non-conscious permanent presence or background 'constant'. It develops over time and emerges out of embodied emotional experiencing with the total environment - both human and non-human. The author argues that it is the rupture of this gestalt and the disorganizing consequences of its loss which underlies the experience of displacement trauma. If disruptions in the formation of the gestalt and/or its later rupture remain unrecognized and unrepresented then the absence creates a void which can be intergenerationally transmitted. Case material is presented which describes this and which highlights the ways in which the gestalt can contribute to our understanding of collective displacement anxiety, cultural trauma and cultural complexes.

La disintegrazione del sé e la rigenerazione della "pelle psichica" nella terapia dei rifugiati traumatizzati

Questo articolo rappresenta un tentativo di comprendere le caratteristiche conseguenze dei traumi estremi, altrove chiamate "!disturbo post-traumatico da stress complesso", che i rifugiati e i richiedenti asilo portano in terapia. Si suggerisce che questo tipo di traumi subiti in età adulta possa comportare una disintegrazione del sé e la perdita della "pelle psichica". Questa concettualizzazione deriva dalla terapia di un rifugiato sopravvissuto a traumi estremi multipli e con il quale sono stati fatti sforzi in terapia per identificare una metodologia complessa che fa uso di strumenti terapeutici supplementari in aggiunta alla psicoterapia individuale. Il caso dimostra come la disintegrazione del sé implichi non soltanto una profonda dissociazione somato-psichica, ma anche la perdita dello spazio intrapsichico e interpersonale. Nel trattamento questo è stato elaborato attraverso la ripetizione delle dinamiche vittima-aggressore a molteplici livelli. Alla fine, il contesto della terapia si è spontaneamente strutturato come una serie di strati concentrici, che hanno creato una "bendatura" sulle ferite del paziente mentre la sua "pelle psichica" poteva rigenerarsi. Le sindromi scatenate dai traumi estremi nei rifugiati mettono alla prova alcuni dei capisaldi della tecnica psicoanalitica nelle terapie individuali, come pure l'idea che la terapia individuale esista in un vuoto ambientale.

Psychanalyse et développements psychiques : le temps à l’épreuve du désir infantile

ContextThe keen observation of emotional and behavioural exchanges between a young child and its parents is part of a long tradition initiated by psychoanalysts such as Anna Freud and Melanie Klein. Considering that these interactions are underpinned by parents’ and children's conscious and unconscious fantasies, clinical observations are compatible with psychoanalysis's theoretical elaboration of psychic functioning. This helps to complete the understanding of complex situations taking place at birth and during early childhood. Moreover, a standardised observation of the interactions between the baby and its family, inspired by development psychology, accounts for the baby's or young child's difficulties in regulating its behaviour, and its sensory, attention, motor, or emotional physiological processes, while considering the contextual aspects. The 0–5 classification, of which a French translation is underway, offers a simple photograph of the present moment, always open to modifications and evolution (Miri Keren, 2018). ObjectivesWith this new knowledge of different orientations, we will explore the necessary dialogue between the developmental approaches and the psychoanalytic study of children and parents, considering their compatibilities and their limits. MethodsThe concepts of containing, the psychic skin, “objeu” (the dynamic of presence/absence during play), and attachment – situated on the border of observation and metapsychological elaboration – are examined in this article. They account for the psychic functioning of the child in relation to others and have proved their relevance in the context of normal situations and in psychopathology. ResultsModels in child psychoanalysis have been developed from both a reconstructive perspective and observation. Such contextual, inventive working constructs allow one to think and elaborate the clinical field of the beginnings of psychic life through heuristic fictions. A better knowledge of the child's developmental context, in terms of emotional and tonic-motor regulations, enriches the data collected during consultations. ConclusionsThe transdisciplinary discussion of development alongside individual and family psychoanalytical clinical practice is necessary because, beyond generating innovative concepts, it also prevents conceptual sclerosis. To remain vital and capable of understanding any human activity, a method should adapt itself to the object studied and not the other way around, for example, by considering the subjectivity of the researcher and the clinician as a resource and not as source of errors.

Shifting Skins: Love and Breakdown

ABSTRACTThis article extends psychoanalytic theories of “holding” and “psychic skin” to examine the containing function of romantic love. It argues that love can function to organize our inner world, helping our lives feel coherent and protecting us from what feels externally threatening, whether projected elements of our own psyches, the risk of breakdown, or true dangers existing in reality. The containing function of love is looked at through instances where it fails, and loss of love precipitates psychic disintegration. Through clinical examples and studies of two novels, Elena Ferrante’s Days of Abandonment and Doris Lessing’s The Golden Notebook, this article proposes that living and loving without illusions of certainty opens possibilities for integrated love with whole and imperfect objects.

The psychic envelopes in psychoanalytic theories of infancy.

This paper aims to review the topic of psychic envelopes and to sketch the main outlines of this concept in infancy. We first explore the origins of the concept in Freud's “protective shield” and then its development in adult psychoanalysis before going on to see how this fits in infancy with post-Bionian psychoanalysis and development. Four central notions guide this review: (1) Freud's “protective shield” describes a barrier to protect the psychic apparatus against potentially overflowing trauma. It is a core notion which highlights a serious clinical challenge for patients for whom the shield is damaged or faulty: the risk of confusion of borders between the internal/external world, conscious/unconscious, mind/body, or self-conservation/sexuality. (2) Anzieu's “Skin-Ego” is defined by the different senses of the body. The different layers of experienced sensation, of this body-ego, go on to form the psychic envelope. This theory contributes to our understanding of how early trauma, due to the failures of maternal care, can continue to have an impact in adult life. (3) Bick's “psychic skin” establishes the concept in relation to infancy. The mother's containing functions allow a first psychic skin to develop, which then defines an infant's psychic space and affords the infant a degree of self-containment. Houzel then conceptualized this process as a stabilization of drive forces. (4) Stern's “narrative envelope” derives from the intersection between psychoanalysis and neuroscience. It gives us another way to conceptualize the development of pre-verbal communication. It may also pave the way for a finer distinction of different types of envelopes. Ultimately, in this review we find that psychic envelopes in infancy can be viewed from four different perspectives (economic, topographical, dynamic, and genetic) and recommend further investigation.

Psychic skin: psychotic defences, borderline process and delusions

In this paper, I apply the concept of psychic skin to analytic work with people suffering from personality disorders and psychoses. When psychoses emerge, the defensive skin which protects the ego is breached and violent unconscious forces rip through the personality. Some of the patients diagnosed as schizophrenic with whom I work have identified with archetypal characters such as Christ, Satan, John Lennon and the Queen. I attempt to show how the adoption of these inflated personas can serve as secondary psychic skins. Such delusional identifications can provide a protective shield to hide the denuded self and prevent intrusion from the external world. Through clinical example, I try to demonstrate how these archetypal 'second skins' can preserve life until internal and external conditions make it possible for the self to emerge. I contrast such psychotic identifications with 'thin-skinned' and 'thick-skinned' narcissism as well as 'defences of the self' in borderline states where the psychic skin may be damaged but does not disintegrate. I also look at the ways in which Jung's own personal experience was different from this and how he managed to avert psychotic breakdown.

CLINGING ON FOR DEAR LIFE: ADHESIVE IDENTIFICATION AND EXPERIENCE IN THE COUNTERTRANSFERENCE

Certain states of mind in a patient are difficult to remain with and tend to evoke defensive countertransference responses which, if enacted, obstruct therapeutic progress. The state of mind discussed in this paper is ‘adhesive identification’, a term that arose out of a conversation between Esther Bick and Donald Meltzer, when Bick said of certain patients: ‘They are sticky, they stick . . .’ The author presents an outline of ‘psychic skin’ defences (Bick, 1968, 1986; Briggs, A., 2002; Briggs, S., 1998; Mitrani, 2001; Turp, 2003) followed by a more detailed account of ‘adhesive identification’ (Meltzer, 1975). Cohen's (2003) work on countertransference and integrity, based on her experiences in a neonatal intensive care unit, is described. These resources are employed as a framework for thinking about countertransference enactments arising in psychoanalytic psychotherapy with an adult, adhesively attached patient. Extracts from a session with the patient, ‘Janine’, are presented and discussed. In conclusion, the author returns to the proposed links between integrity in the sense of thoughtfulness and respect and integrity in the sense of the felt experience of being in one piece within a skin boundary.

The ‘autistic’ level of the Oedipus complex

In this paper, the author describes some of the tripartite constellations occurring in the material of children on the autistic spectrum. These could be thought of as constituting a primitive, ‘autistic’ level of the Oedipus complex where the fundamental anxieties are existential ones. It is suggested that these fears of annihilation are experienced on a bodily level, and that this physical aspect appears to be a distinguishing feature of the experience of the Oedipal constellation in children with autism. The clinical illustrations concern the experience of bodily mutilation within the feeding relationship; Oedipal aspects of sense perception; the nature of the link between masculine and feminine elements making up the psychic skin; and the balance between the child, the mother, and the mother' internal figures. Some implications for cognitive development are discussed.

Psychotherapy with an adolescent boy who refused medical treatment

In this paper we describe psychotherapeutic work carried out in a paediatric hospital to illustrate the important contribution of a psychoanalytically-oriented approach in a hospital context. The work concerns an adolescent boy who had undergone several surgical operations with the result that some of his natural orifices were obstructed and artificial ones had to be created. He was referred to us because he refused pharmacological and rehabilitative treatment necessary prior to further surgery and his eventual recovery. The boy's experience of loss of control of his life and the more primitive anxieties of not feeling safely contained in his physical and psychic skin emerged and were worked through in the psychotherapeutic relationship. The parallel work with medical staff reduced the risk of splitting and acting out by the patient and professionals. The approach adopted enabled this boy to resume his medical treatment and his developmental process.

Self-harm by omission: A question of skin containment

This paper explores the phenomenon of ‘self-harm by omission’ and its relationship to other kinds of self-harming behaviour and to disturbances of psychic skin functioning (Bick, 1968). Process material from work with a patient ‘Kate’ is introduced to illustrate and clarify the matters under consideration. The conceptual framework provided by psychic skin theory is described, with particular reference to the defences of ‘toughening’ and ‘porosity’ and their relevance to understanding different kinds of self-harm. Arising from this work, suggestions are advanced with regard to further development and an extended range of application of a ‘skin containment’ conceptual framework.

Médiation de l'eau dans l'autisme : Joachim ou la construction d'une première peau psychique

The structure of water-play — a room with a shallow pool and a dry area, equipped with taps, shower-pipes, mirror and toys — make up a particularly interesting indication in the treatment of autism. The therapeutic work is actually centred around recovering an initial feeling of an envelope, thanks to the exploration of specific characteristics of this structure, which correspond for the child to the spatial projection of his physical envelope. The mediation of water enables notably an effort of sensory integration to be made, which is fundamental for the autistic child, from the sensory dimension of this therapeutic space, the various methods of linking with the therapists, who will make use of all the sensory registers, through to emotional chords. This article will stress the role played by the interaction of visual, tactile, oral exploration; by the work on the sound envelope and by the exploration of the material framework in the task of constructing a psychic skin in an autistic child.

A skin for the imaginal.

This paper focuses on the development of internal space, the evolution of psychological boundaries and the capacity for symbolization as they first arise during infancy. The concept of the psychic skin as an early form of psychological boundary is presented. The development of the psychic skin, or psychological container, is necessary for imaginal processes to function for the purpose of psychological growth and development. Infant observation material utilizing the Tavistock model and analytical material from an adolescent analysis is presented to help elucidate the theoretical concepts.

The skin as a means of communicating the difficulties of separation—individuation in toddlerhood

Because the skin is a fundamentally important means of communication between mother and child, skin problems disturb this relationship and can lead to a disturbance in the concepts of the self linked to narcissistic difficulties and to an acute sensitivity to object relationships. In psychoanalytic terms, the ego or psychic skin is a metaphor for the biological skin and the psychic skin depends on the bodily. skin. This paper considers the metaphorical link between the biological skin and the ego, by drawing on weekly observations, made over a ten-month period, of a male toddler who suffered from infantile eczema. His skin problems seem to reflect his struggle during the separation-individuation process of toddlerhood. His eczema is shown to be a metaphor for his apparent feeling of inconsistent containment, his difficulties in developing a positive concept of the self that has ego strength, and his difficulty in expressing aggression safely.

UNDERSTANDING THE TRAUMA OF RACIAL VIOLENCE IN A BLACK PATIENT

ABSTRACT Racial violence arises when infantile anxiety and hatred of ‘difference’ or ‘otherness’ become too unmanageable within the self and are displaced into the racial arena via splitting and projective mechanisms. The body of the ‘other’, particularly skin colour differences, becomes a salient target for locating and attacking these feared and unwanted aspects of the self.Those on the receiving end can experience a profound attack on their identity, with feelings of rejection that can result in a severe narcissistic blow, puncturing and even shattering the individual's psychic skin and existing defensive organization. This failure of containment can send tremors throughout the psyche to some of the most vulnerable areas in individuals functioning, giving fresh life to both oedipal and pre‐oedipal anxieties to do with separation and loss.Where these early anxieties are felt to be unbearable, the individual resorts to encapsulating them in a portion of their mind, effectively sealing them off from conscious awareness or access, but they are unconsciously re‐enacted. A case study aims to describe some of these phenomena.