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This paper describes a problem associated with the analysis of a three-year-old boy Robert, whose presenting symptoms were an inability to talk, understand, or hear. His rôle of the mute sad-eyed child was so important to his family that the analyst had to research into the family dynamics, build up a treatment team, and at times of stress alter the focus of the analysis. In other words she came to appreciate that this was a family using primitive invasive and incorporative defence mechanisms, so that whenever the patient responded to treatment the other family members felt their rôles threatened and the family balance gravely disturbed.
Lomas (9) recently described the illness of an adult patient as a 'failed attempt to establish an identity of her own as opposed to one forced on her by the family'. The problem for Robert's family was whether they could afford to allow him to become an individual. Wynne (13) describes this as a characteristic dilemma of families having a pre-psychotic organization. Divergence from the family rôle structure is seen as likely to lead to disruption and chaos, but if divergence is avoided no growth is possible within the prescribed relationships.
This paper outlines how each family member had to experience an emotional disturbance as his own rather than Robert's and to understand some of the causes for it before Robert's steady improvement could be accepted by the family, and therefore maintained by their unconscious attitudes. The family had to find alternative ways of dealing with feelings of anger, rivalry, and sexual excitement which then allowed them to abandon the regressive device of one family member accepting the rôle of the sad-eyed mute discarded child; and the analyst had to find a way of helping them.
The present paper focuses on this aspect, that is, the making of a setting in which the child's analysis could go forward; but it should also be emphasized that a great deal of the boy's analysis followed an orthodox patte