‘To Walk the Last Bit on My Own’ — Narcissistic Independence or Identification with Good Objects: Issues of Loss for a 13-Year-Old Who had an Amputation

This paper describes two years of psychotherapy with Michael, a 13-year-old boy who had undergone a recent emergency amputation of his leg and hip for bone cancer. The work follows Michael's struggle with the enormity of the loss, in the face of his, as well as the system's, use of denial. The amputation as an ‘attack’ on his physical and emotional autonomy strikes at his early adolescent development. The therapeutic process is aided by his capacity ‘to go back to the unhappiness’. The therapy develops from his initial shock, to despair and self-blame, as he struggles with a tendency — in the middle period of the therapy — to lose his mind as well as his leg in a retreat to withdrawal and mindlessness, or to mania. He struggles between an omnipotent, at times self-destructive, wish to ‘go it alone’, versus a capacity to feel sad and to value life. His capacity to think about the trauma and to find meaning emerges. The paper raises questions about whether some trauma can ever be fully assimilated, and whether, for Michael, the mourning process could lead to a reintegrated sense of self and of a ‘psychic intactness’, dependent on the survival of his good ‘internal couple’.

Hospital and ward-based child psychotherapy and its limitations are explored.