Clinical Commentary 46

In clinical commentary 46 we hear about a patient, a woman, emotionally deprived in childhood, whom our first commentator tells us longs for intimacy but who also avoids it. All three commentators write about this lack and its effects, which, over time, becomes a presence that fills the patient's life and takes precedence in relationships. This, we learn, appears to hinge symbolically on a kiss, or rather the absence of a kiss, the kiss of a parent and its accompanying legacy. We know there are many different forms and meanings a kiss may take, including as our first commentator introduces, the theme of betrayal, which also brings to mind the kiss of Judas. In the case of the patient it is the missing kiss that has the devastating effect, which our second commentator describes as a lack of ‘somatic communication’, reminding us how the physical sensation of touch is necessary to keep good objects alive in a patient's mind. One only needs to watch parents saying goodbye at a school gate to see that for a young child, a kiss marks both love and affection but that it is also the moment of release, a gesture offering the child independence, signifying a vital confidence that the child (and parent) can survive the separation. Another example, are children growing up in boarding schools who may defend against this emotional deprivation via the excitement of late night dormitory high jinks, but without a good night kiss something elemental is missing, the night is left open and unsafe, sometimes literally. When a child falls over and scrapes their knee it is not the plaster or the antiseptic that heals but more often than not it is the kiss, as we read in our third commentator's description of the patient's ‘muted response’ to her objects as a result of this absent kiss and what is left behind. The lasting effect this has on the patient is unanimously felt and understood by all three commentators as we discover below. Finally, I would like to thank the clinician