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The many facets of the mind-body problem — psychosomatic diseases, hypochondria, somatic delusion, morbid grief (Leiberman), anxiety about minor bodily discomforts — together constitute an extensive area of general practitioner responsibility.
Bion's contribution to this area springs from his concept of a hypothetical matrix in the human organism, in which physical and mental are at first undifferentiated. This matrix he called, in his book Experiences in Groups, the ‘protomental system’. He presented a view of group mentality in man, the herd animal, whose basic assumptions about the world are closely bound to action rather than thought, and serve to evade frustration, rather than think about it. Each of the three basic assumptions (dependence, fight-flight, pairing) may, he suggested, when in abeyance, be associated with psychosomatic illness.
Bion's contribution has been placed in context by Meltzer: ‘Freud was trying to describe the distribution of the libido and its vicissitudes. Mrs Klein was bringing these into the sphere of object relations, and Bion is attempting to account for the development of thought and learning within the confines of object relations, and thus for their pathology.’
Bion's argument is that there is a continuing dilemma for the human being, between his membership of a group at the basic assumption level — which is close to mindlessness — and his capacity to combine with others for thought and work. The implication is that the family ultimately emerges as the prime example of the work group, and from experience of object relations within the family the infant is able to develop his individuality.
Subsequently, extending Melanie Klein's concept of projective identification, Bion evolved a theory of how the capacity for thinking about frustration and mental pain, rather than evading it, might come about.
Freud replaced his initial concept of anxiety as ‘unsatisfied libido’ by relating it to the child's painful feelings of tension in the absence