The Body as Bondage. Work with Two Children with Physical Handicap

In this paper I would like to share my experience of working with two children both of whom suffered from severe congenital handicaps. In each, case, the surgical correction of their deformities involved repeated operations, forced immobility and lengthy stays in hospital. In particular, I will be focusing on the relationship which often exists when there is structural damage to the body (especially when it is of a chronic nature) and corresponding emotional and psychic damage to the “self’. In order to clarify what I mean by the relationship between bodily and psychic processes, I would like to refer to Esther Bick's article “The Experience of the Skin in Early Object Relations”.

In her paper, she talks about the function of the skin of the baby as a “boundary” which contains and binds together parts of the personality which have not yet been differentiated from physical functions of the body, and that, in the primitive undifferentiated state of the psyche, acts as a “physical” container of parts of the personality. She goes on to suggest that this role of the skin as a container becomes gradually superseded as external objects become introjected to form an “internal” boundary or container to the “self’. This implies that at a very primitive symbolic level — before there is a differentiation between body and self and self and “other” — psychic functions are closely related if not actually derived from, bodily functions. This can be readily seen in our everyday use of imagery and metaphor derived from physical states or processes to describe psychic functions or attitudes. So, for example, if someone is insensitive we call them “thick-skinned” or “callous” and if too sensitive, “thin-skinned” or “soft”. If someone succeeds in getting under our defences and “getting through to us” we say that they have “got under our skin”. Given these links, it should not surprise us too much that traumatic damage to our physical structure can lead to damage to our mental