Psyche/Soma Issues for an Adolescent with Spina Bifida* and Mental Handicap

“The link between intolerance of frustration and the development of thought is central to an understanding of thought and its disturbances” - Bion, Learning from Experience (1962)

In this quotation Bion is referring to Freud's understanding of the part played by intolerance of frustration in producing tension, and to its relief, by the employment of thought to fill the interval between the need to relieve the psyche of “accretions of stimuli” and the actual unburdenings.

This understanding of the development of thought is necessary background to that which follows.

Sharon is a large, lumpy young woman, aged seventeen, with spina bifida* and hydrocephalus**. She is paralysed from the waist down, so is doubly incontinent and of course confined to a wheelchair. Her legs are spindly, in contrast to the rest of her body, which is overweight. Her skin is spotty, her features generally unattractive. Her nails are very bitten, the skin around them picked at. Her I.Q. is 47. Her favourite books are the “Mr. Men”. More evocative than my description is the account the art teacher gave me of a self-portrait Sharon had done: “Large head, large barrel-body, no neck. The legs were two thin stumps with no feet. The hands outstretched. On the face was an awkward expression. The eyes were closed”. She has a younger sister aged thirteen and a brother of eleven, and lives at home with her mother, siblings, and, sometimes, mother's co-habitee. The parents separated when Sharon was sixteen, but father still has quite close contact with the family.

I was asked to assess her with a view to taking her on for once-weekly psychotherapy by the Head of a day school for physically disabled children where I saw a few children regularly, and met with the staff at least once a term to share our thoughts about some of them. Sharon was referred because the staff and some of the pupils found her self-destructive