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An ongoing, shape-shifting challenge of doing psychoanalytic work, even with the benefit of experience, is tolerating and working with negative mental states including deep pain, emotional and somatic, and anger/rage, accessible and split-off. Enactments, impasses and confusion occur when such feelings emerge at the cusp of conscious and unconscious experience in both patient and analyst. Good analysts wrestle with these initially intolerable states and risk traversing unknown territory in order to create traction in their patients as well as themselves; yet, when unmentalized territory includes trauma, with its primitive reach into the body, analysts may encounter inexplicable, wordless and catastrophic sensations with no identifiable pathway of using the self to access pain and deepen the treatment.
Trauma and Primitive Mental States: An Object Relations Perspective offers a personal, deeply evocative synthesis of object relations theory – featuring the work of Bion, Klein, Ferenczi and Meltzer among others – to elucidate the use of oneself in treating patients who have experienced early psychic trauma. Although this contribution may be applied to various forms of neglect and suffering, including severe postpartum depression, Eekhoff uses babies in neonatal intensive care units, separated from their mothers’ bodies at birth, as the prototype for her clinical understanding. The unmediated distress of these infants’ medical conditions often combines with unavoidable failures in the caregiving environment to stunt growth, encapsulating them in primitive mental states and leaving them with only pre-mentalization defences such as suspension, adhesion and mimicry. As adults, they remain frozen in pain and passive despite their capacities to function in the world as brilliant, obsessional automata. Trauma and Primitive Mental States is the product of a sensitive and experienced psychoanalyst’s meditation on the paradoxes inherent in facilitating growth when “critical peri