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Jill Miller's paper about Julia's analytic treatment is both very moving, in the pathology linked to early and repetitive somato-psychic traumas endured by the child, and extremely rich in technical situations for the psychoanalyst to think about.
To begin with the traumatic illness, one has to figure out baby Julia's terrifying panic attacks, being trapped between her internal sensation of unbearable pressure, and the many brutal intrusions of emergency hospitalisation and surgery, coming from outside. Besides, the doctors had prepared her parents for a fatal outcome. How could Julia have developed any safe feeling of self-existence?
Miller describes Julia on their first meeting as a 5-year-old girl who was ‘in a state of panic, at times hysterical and inconsolable, could not be left alone and was having nightmares’. Obviously, her parents' excellent capacities to support Julia had by now been overwhelmed by her state of terrible excitement and anguish, which was impossible to contain properly. Needless to say, had she not had early, intensive and prolonged psychoanalytical care, Julia's future would have been a severe mental retardation, or maybe sheer madness.
Miller outlines how she attempted to help Julia to detect her defensive use of regression to a state of confusion when confronted with frustration and helplessness. She certainly worked hard to help the child differentiate between the violent sensorial, pathological sensations coming out of her damaged brain and the violent emotions and feelings, especially rage, aroused in the transference situation.
She goes on to describe how she succeeded in becoming for Julia an external object of containment and projective identification, in a way that I would relate to Bion's concept of ‘maternal capacity of reverie’ (1962). She ‘loaned’ her own drives’ organisation and ego-superego structure to Julia's disorganised, or maybe non-organised, traumatised Self to help a better intrication of life and death instincts into se