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The theme of emptiness had been most salient for me in my work with women (Charles, 1999), for whom reciprocal experiences of internal emptiness and external void are often highly charged, evoking images of creation and birth. These themes are particularly at issue for women who have not felt ‘carried to term’ by their own mothers, and search, often with little hope, for ways in which to feel ‘held’ within the object world. In my work with women, images of emptiness have been evocative of the contours of my own physiology; the consulting room becomes the womb within which the self might be newly delineated in this precarious cocoon of care set within the larger, and often terrifying, void. As I have continued to reflect on this theme, however, I have become more aware of similar images in my work with men, images that evoke the physical feel of being unheld in an uncaring universe, thereby configuring an internal world that cannot hold the self safely or lovingly. For men, too, the counterpoints of full versus empty and touch versus absence evoke this intertwining pattern of convex and concave. There may be no experience that poses a greater challenge to the analyst than to sit with our patients in these vast, fathomless, unfound spaces. As I have done so, I have become intrigued by similarities and differences in men's and women's depictions of their experiences of what have been characterized by Balint (1963) as ‘internal emptiness’ and ‘external void.’
The void appears to have its origins in early deficits between infant and caretaker, when holding is absent or unresponsive to the developing child (Stern, 1985). For our patients, the internal void becomes fashioned in the image of the external one, and vice versa. To imagine filling either is to invoke images of excruciating pain as the rawness of unsheathed flesh is revealed. To admit internal emptiness is to acknowledge need, whereas to acknowledge the external void is to affirm one's inherent unlovability in th