Meetings of the Psychoanalytic Association of New York

February 24, 1986. EARLY SOMATIC ILLNESS AND PAIN REPEATING: ENACTMENT AND VERBALIZATION IN THE ANALYTIC SITUATION. (12th Melitta Sperling Memorial Lecture.) James M. Herzog, M.D.

Dr. Herzog presented clinical material from three analyses which served to elucidate the relationship between early painful somatic experience and character development. In addition, he illustrated how a preverbal child's experience of pain may be communicated to the analyst via nonverbal language. The clinical material presented in greatest detail was from the analysis of a child who was in treatment for several years, beginning around the age of three. The birth history revealed that her mother had had a vaginal-anal tear during delivery, with painful sequelae. Dr. Herzog was first consulted when the child was three months old. She had an anal fissure and was constipated. When she was fourteen months old, the father called, saying the problems was worse. A medical workup had revealed normal physiology, and psychiatry had been suggested. The child was seen at eighteen months and quickly warmed to Dr. Herzog. They played a game of her invention, examining the front and back of two dolls, Ba and Da. Although she was responsive, her mother refused to bring her back because her own analysis as a child has been "a disaster."

But the child's bowel problems persisted. She defecated on the floor every six to fourteen days, and would lie next to the pile of feces until her mother cleaned it up. The mother sought help for her when the child was about three years old. On entering treatment, she asked to play with Ba and Da, but she had also brought a doll of her own, Humpty Dumpty. Humpty "observed" and "narrated" but was not permitted to examine Ba's back, nor was Dr. Herzog. The child said there was a large red light behind Ba which said stop, and a small green light which said go in front of Da. One day Ba had a stomachache, and, in wondering what might help, Dr. Herzog suggested