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There is a great deal to appreciate in this article. The depth and breadth of the resources the authors cite, the links they make between them, and the detailed clinical case material makes this instructive and thought provoking. As the title suggests, the emphasis in the clinical material is on the resolution of the
somatic symptom. Nevertheless, much of the discussion revolves around the dynamics of dissociation and wholeness. Much of this patients’ suffering was dissociative in nature. The image of being behind a glass wall and that of having the analyst in a dinghy that could be pulled close and pushed away illustrate a rather schizoid phenomenon . Although this is not the focus of the article, the vignettes are so rich that they could be used for teaching this material.
They generously offer theoretical ideas woven among the clinical vignettes. They dedicate a solid piece of work discussing differences in thought on symbol formation between Bion, Aulanger and Rudolfo laying theoretical groundwork in the case of Mr. B. They sweeten the intellectual pot by centering their reflections on the following citation from Bion:
He is always thinking, thinking. Where? In his head? Or in his stomach?…It is possible to speak of someone having “his belly as his god”. Similarly we can say that people have as their god the intellectual life…. There can be such a thing as too much cerebration, the cerebral hemispheres used to the detriment of the sympathetic or autonomic system. And so the marriage between this patient and himself has never really been consummated.
Metaphorically speaking, Mr. B. was not married to himself. His psychological condition manifested somatically, not yet understood as psychic pain. The patient believed he had an actual heart condition even though he sought regular medical check-ups that showed no cardiac disease. The authors discuss the physical symptoms (painful heart arrhythmias) as beta elements (Bion) that were not yet able to be