Academic journal article International Journal of Psychoanalysis

From Acting to Communicating: The Analysis of a Boy with a Pathological Organization1

Academic journal article International Journal of Psychoanalysis

From Acting to Communicating: The Analysis of a Boy with a Pathological Organization1

Article excerpt

The author presents the analysis of an 8 year-old boy prematurely born after a high-risk pregnancy, then hospitalized for two weeks. He was never breastfed and presented vomiting, intense activity and inadequate behaviour as symptoms. His highly dysfunctional family is composed of a non-productive father and a homely, though aggressive, mother. The patient displayed a rigid defensive structure with perverse aspects and a cruel superego. His constant interest in magical characters frequently disguises an avoidance of reality. By means of transference interpretations, a trustworthy link with the analyst now allows him his own mental space, where hidden psychotic states come to light. In the clinical material, this boy's skills for insight mingle with oscillations from severely defensive states to integration and vice versa. The analytic relationship in this often hostile scenario has become strong. The analysis is hampered by constant demands from family and school-both expect the analyst to prevent his frequent acting out. Whereas some perverse polymorphism is part of childhood and may persist throughout life, it is likely that the patient's pathological organization may yield to reality and facilitate reparation, relinquishing the world of make-believe as well as the intense projective mental functioning.

Keywords: pathological organizations, polymorphism, defences, perverse states, psychotic states, projective identification, goofiness, vomiting, fairytales, topsy-turvy


In the first chapter of The psycho-analysis of children, Melanie Klein (1932) reminds us that, as with the belief in infantile asexuality, one no longer believes in infancy as paradise. Once babies were seen as having an incipient capacity to form relationships, to create phantasies, to project them, to defend themselves, and to suffer, the child's world became more complex and decidedly less of a nirvana. Add this to the commotion Freud (1905) created when he attributed specific characteristics to childhood sexuality, postulating a perverse polymorphism as an integral part of normal child development. Also, this polymorphism would not necessarily be adult perversion. Indeed, during childhood, characteristics derived from that polymorphism, even when they are exacerbated, should not be thought of as perversions if they can be understood in a different fashion.

The motivation for this article comes from my treatment of a child's pathological organization, one that I believe to be quite rare in childhood. I examine his perverse traits and his use of them as defences. I use Steiner's (1987) 'pathological organization' in identifying specific cases where his defences play a preponderant role in a desperate attempt to avoid the emergence of insanity. Still, psychotic nuclei underlying perverse states such as these prevail.

Melanie Klein and her followers-when they allow for unconscious phantasies, which, very early on, inform babies' relationships with their objects-suggest the uniqueness of each internal world interacting constantly with the external world. This interaction will orient an analyst's work. Object relations and the corresponding anxiety in every moment of those encounters, projective identifications and their destinations as relived in the transference will be a scenario in which the wisdom (or lack thereof) will unravel in every dyad that is formed. This begins at birth, or even before, and it becomes a template for babies' future encounters, as they grow, become adults, and get into analysis.

When one considers the model in which the mother's mind (the container) processes the baby's projected suffering (the contained), good conditions for the development of adults with minds of their own will be created, provided the baby also contributes some favourable characteristics. This process of 'detoxification' on the mother's part, using the a-function, has been called the capacity for reverie (Bion, 1962, pp. …

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