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DR. LEFER'S PAPER is a valuable contribution to the psychoanalytic understanding of a somatic condition in which psychological factors are known to play an important role. It has particular significance because: (a) it is one of the very few studies published by a psychoanalyst about rheumatoid arthritis; and (b) it comes to light at a time where psychoanalytic studies of psychosomatic phenomena are at their lowest ebb, having been replaced by laboratory and multidisciplinary team research.
The concept of fusion is intriguing as a theoretical underpinning to an understanding of the dilemmas of the two patients described. Fusion as an explanatory, germinal psychological concept requires definition. Can fusion, be differentiated from symbiosis, dependency, clinging, love, ideological conviction, faith and, in general, from any feeling that tends to approximate two individuals or one individual with an object or an idea?
Winnicott (1953), Rosenfeld (1958-1962), and Bleger (1964) describe a state of primitive confusion, a lack of differentiation