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The panel offered a unique opportunity to look at a topic that has been largely foreign to psychoanalysis. In her introductory remarks, the moderator, Jennifer Johns, prepared the audience for what proved to be a very challenging and enlightening set of presentations. Some of the cases raised E. Ticho's ‘heroic analysis’ to a new height.
In the first presentation Valerie Sinason, of London, described a very disturbed and disturbing patient and her courageous, original treatment. The patient, an adult woman who functioned physically and also emotionally at a very primitive level, was incontinent and paralysed and had been institutionalised most of her life. She had been treated in spite of the fact that her potential in life was defined by the maintenance of a very limited biological existence. The analyst's genuine empathy and commitment allowed for the investigation of the possible meanings of the patient's behaviour, rather than this behaviour being seen as the consequence of neurological deficit. At one point, which coincided with the anniversary of the patient's abandonment by her family, the patient tested the limits of the analyst's capacity to accept her very regressed and mainly angry and aggressive behaviour. It was possible to interpret such a reaction in a very meaningful, compassionate and most useful manner. The analyst's countertransference, in the ‘totalistic sense’, guided her to more effective interventions.
James Rose, also of London, approached the problem of physical impairment from the perspective of secondary gain, as a struggle between ‘the healthy’ and ‘the ill’ aspects of the personality. Rose used Main's The Ailment (1989) as a way of organising his hypotheses about the patient's illness. According to Rose, patients with physical impairments relate to their analysts through the illness, assuming that this is the only aspect in which the analyst is interested. Together with the sense of ‘specialness’ that they experience, the stage gets set fo