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Projective drawings have long been an invaluable tool in understanding the nonverbal, preconscious world of the patient, and it is well established that the drawings of children who have suffered physical and sexual abuse display predictable variations in the representation of visual symbols. However, careful attention to the individual symbol system of young children can reveal the unexpected, particular ways that trauma may be recorded in nonverbal and kinesthetic dimensions, especially when the trauma occurs before the acquisition of language. This essay explores the history of the psychoanalytic approach to the visual arts and the central ideas about the process of image-making in response to loss. A case is then presented in which one child’s idiosyncratic visual symbol became a powerful communication between patient and therapist, through its ability to evoke a mutual, nonverbal, kinesthetic experience. Through the mechanism of projection, visual symbols can serve as a meeting ground in which the therapist may be able to participate in some of the nonverbal aspects of the patient’s experience. In this instance,
Fellow of the American Psychoanalytic Association, 1995. The author is a psychiatrist in private practice in San Francisco and is also a board-certified pediatrician with extensive experience with children in the foster care system who were victims of sexual and physical abuse.
Presented to Grand Rounds at California Pacific Medical Center, June 6, 1995.
The author is indebted to Dr. John MacGregor for his inspired history The Discovery of the Art of the Insane, Dr. Harry Cohen for his encouragement, Dr. Robert Friend for his warm clinical example, Dr. Uwe Jacobs for his helpful comments, and to Dr. Charles Fisher for his mentorship and constant support.
The Psychoanalytic Study of the Child 52, ed. Albert J. Solnit, Peter B. Neubauer, Samuel Abrams, and A. Scott Dowling (Yale University Press, copyright © 1997 by Albert J. Solnit, Peter B. Neubauer, Samuel Abrams, and A. Scott Dowling).
the emergence of a stable visual symbol in the intersubjective field facilitated first an unconscious identification with the patient and then a conscious understanding that had a mutative impact on the child’s ability to organize nonverbal affect states within the therapy. This chapter illustrates the utility of a psychoanalytic understanding and attention to symbolic communication in a child whose manifest anxiety was phenotypically indistinguishable from Attention Deficit Disorder.