On Being Cut Out of the Dead Mother

This article suggests a new understanding of patients who suffer from extreme avoidant tendencies and psychic developmental arrest. The etymology of Freud and Bion's term “caesura” is traced and linked with the practice of Roman Caesarian section. In this practice, which was carried out when the continuation of pregnancy endangered both mother and fetus, the fetus was cut out of the womb, resulting in the mother's death. The author suggests this practice as the prototype of an unconscious phantasy underlying the symptoms of extreme avoidance and developmental arrest in a certain group of patients. This suggestion relates to neo-Kleinian ideas (Rosenfeld, Meltzer, Steiner), combined with Green's term “Dead Mother”. In these patients' phantasmatic world the consequence of coming to life means the death of the other. They are unable to deal with continuation over the caesura of psychic birth. The analytic relationship with these patients is discussed. Clinical material is presented in order to demonstrate the appearance of this phantasy in the analytic setting. It is suggested that this conceptualization may aid the therapist in distancing himself from the collusion created by the excessive projective identifications characteristic to these patients, thus helping to work through the impasse created in therapy.