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Commentary: helping patients develop a 'psychic skin'.

Many patients come to my practice with concrete skin and containment issues manifested by cutting, mutilating the body, extensive piercing, and tattoos. As a Jungian analyst, much of my understanding of these patients is seen through the lens of that great Swiss psychiatrist, Carl Gustav Jung.

Jung was an isolated child whose father was a minister and whose mother was severely depressed. She was psychiatrically hospitalized when Jung was 3, after which he developed severe eczema, and his confidence in intimate relationships was eroded.

In childhood, he developed suicidal impulses, and while his mother was hospitalized, a maid saved him from having a serious accident while crossing a bridge over the Rhine Falls. I wonder about the extent to which his accident proneness was tied to feeling uncontained in his relationship with his mother--and to the rage directed against himself rather than to his emotionally unavailable mother.

His subsequent theories reflected his belief that one must turn inward to manage life's problems rather than look to others.

My own clinical/analytic work has supported research showing that cutting can represent difficulty in both experiencing and tolerating feelings. Some patients are psychologically "skinless." Loud noises seem to go through their bodies. Others feel as if their skin is leaking. Very often for those patients, parental neglect and significant attachment difficulties are evident. In other words, we can help some patients who are in analysis if we understand the concept of a psychic skin. I have seen this concept at work while watching infant-parent interactions.

The secondary skin function develops to manage terrors and fear. It also uses the musculature or other self-soothing behaviors to hold the self together through rocking, scratching, making sounds, and clinging to inanimate objects. The primary skin function forms through the secure attachment to the caregiver and evolves to hold, contain, and regulate the infant's affective states.

I observed this secondary skin phenomenon in the case of a 5-month-old girl. When I arrived at the infant's home, she was sitting in her baby seat in the family room, and her mother was about to leave for work. The mother left the room and returned several times, while the caregiver sat in the kitchen. The baby's eyes were dearly focused on her mother.

After a few minutes, the mother left the room without interacting with or saying goodbye to the infant. There was a lack of any transitioning for the baby. Immediately, I noticed that the baby's body became taut and rigid. After a few minutes, she began rocking her body back and forth in the chair, and making back and forth head movements. When the caregiver took her out of the chair, the infant became more fussy and began to cry Soon afterward, the infant focused on a rubber nipple and began drinking voraciously.

My theory is that the infant's separation from her mother led to her feeling cut off from the mother and emotionally uncontained. She tried to gain control of her anxiety by making her musculature frozen and stiff--and gulping down the formula.

There are lessons here for those of us who work with patients with a host of psychiatric problems, ranging from borderline personality disorder to narcissicism to eating disorders. Women battling the latter have told me about their binges being associated with feeling dysregulated, disconnected, and dissociated. The lack of containment they have felt had led to a sense of enormous dread.

As mental health professionals, we can assist patients if we understand how the psychic skin as a container of emotional experience develops, and how the experience of the somatic skin transforms into an internalized psychic skin, thus providing a safe and secure inner space for psychological growth and development.


Dr Feldman is a child, adolescent, and adult analyst, and an infant observation (Tavistock model) seminar leader who practices in Palo Alto, Calif Scan the QR code to read more Commentaries at
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Title Annotation:OPINION
Author:Feldman, Brian E.
Publication:Clinical Psychiatry News
Date:Mar 1, 2013
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