You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
DISCUSSION: Dr. Robert Kenerson commented that this case illustrates the usefulness of psychoanalysis for patients with preverbal pathology. Christopher seemed to be seeking a sense of self and was, in Goldberg and Gedo's terminology, at the stage of unification. Psychoanalysis can be used to create a stage for verbalization of affect which must be developed before any interpretation can be more than a mere intellectual game. Dr. Samuel Silverman noted that acting out seems to be an alternative response to somatization in many of these patients. Dr. McDougall agreed, mentioning that addictive patterns of behavior, including substance abuse, compulsive sexual activity, and primitive vampirizing object relations, were other ways to disperse emotions and that sometimes when these patterns diminished, somatization increased.
Dr. Jerome Sashin focused on the question of how to explain the shift from somatization on day one to dreaming and affect on day two. He pointed out that in Goldberg's Psychology of the Self there is a similar episode: Mr. I had come to analysis showing considerable impulsivity and somatization, but over the course of treatment, these response patterns had diminished as he developed a capacity to feel and to verbalize his feelings. Late in his analysis, after the analyst's vacation, Mr. I reported that he had had severe somatic symptoms during the prior weekend and that also he had had no dreams or fantasies, which was unusual for him. The elaboration of imagery seemed to be related to the ability to experience his feelings, and consequently the absence of imagery formation seemed to be limiting the affect being felt.
Dr. Frances Bonner stated that she believed that there was more than deprivation of words; that lack of maternal care in Christopher's case had resulted in the impairment of many ego functions, especially self-care functions. She felt that the key moment in Dr. McDougall's sessions with Christopher was her acknowledging that th