The Blossom Tree and the Number 4: Some Ideas about Thought Disorder in An Adopted, Diabetic Boy*

It was during the course of my Infant Observation and supervision with Mrs. Harris that I was introduced to concepts that were of tremendous importance in my work with the boy who is the subject of this paper. One of these, the idea of skin containment, came up many times in our Infant Observation Seminars; the others, from her supervision of a borderline child, are Bion's ideas on thinking and the place of the mother's maternal reverie in creating the conditions necessary for the internalisation of a thinking object.

My patient, Michael, whom I have been seeing in four times a week psychotherapy since January 1984 when he was eleven, is an adopted boy who developed diabetes when he was 4 years 7 months old. He came into therapy with reports of his being “unbearable” both at home and school - a chaotic, argumentative and disruptive boy, prone to outbursts of inappropriate “silly” behaviour, but with no real indications initially as to the depth of his thinking disorder.

Diabetes is an illness whose onset undoubtedly creates the catastrophic change that Bion (1970) talks about, in the sense of an emotional explosion when all previously held views of life are thrown into disarray. One can imagine what the impact of a daily injection of insulin might have on a child's experience of his skin as an adequate - or rather inadequate - container, with all its psychological parallels.

This in itself, therefore, might seem to be enough to explain Michael's difficulties in thinking and learning, but I am going to suggest in this paper that Michael's capacity to think about himself and his relationships both to his internal and external worlds was impaired and well-nigh shattered long before the onset of his diabetes. It is my opinion that it was his removal from his natural mother at six weeks old, followed by pre-adoption fostering before final placement with his adoptive parents, that had the catastrophic effect on his capacity to think that seems amply illustrated in his materi